Quality of decision aids developed for women at average risk of breast cancer eligible for mammographic screening: Systematic review and assessment according to the International Patient Decision Aid Standards instrument

Abstract

Mammographic screening contributes to a reduction in specific mortality, but it has disadvantages. Decision aids are tools designed to support people's decisions. Because these aids influence patient choice, their quality is crucial. The objective of the current study was to conduct a systematic review of decision aids developed for women eligible for mammographic screening who have an average breast cancer risk and to assess the quality of these aids. The systematic review included articles published between January 1, 1997, and August 1, 2019, in the PubMed, Embase, Cochrane, and PsycInfo databases. The studies were reviewed independently by 2 reviewers. Any study containing a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. Two doubleblind reviewers assessed the quality of the selected decision aids using the International Patient Decision Aid Standards instrument, version 3 (IPDASi). Twenty-three decision aids were extracted. Classification of decision aid quality using the IPDASi demonstrated large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172). Three decision aids had high overall scores. The 3 best-rated dimensions were disclosure (maximum score, 8; mean score, 6.8), focusing on transparency; information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details; and probabilities (maximum score, 32; mean score 25), focusing on the presentation of probabilities. The 3 lowest-rated dimensions were decision support technology evaluation (maximum score, 8; mean score, 4.3), focusing on the effectiveness of the decision aid; development (maximum score, 24; mean score, 12.6), evaluating the development process; and plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy. The results of this review identified 3 high-quality decision aids for breast cancer screening. Cancer 2020;126:2765-2774.Breast cancer is the leading cause of women's mortality worldwide. 1 Screening programs based on mammography lead to a 15% to 20% reduction in specific mortality. 2,3 However, assessing the benefits and harms of these programs requires taking into account the biases and disadvantages of mammographic screening. 2 The most important harms of this screening are false-positive results, overdiagnosis, overtreatment, and radiation-induced cancer. 4 The cumulative risk of a false-positive result ranges from 3% to 63% for a woman exposed to annual mammographic screening between ages 50 and 70 years. 5,6 In this context, clinicians may feel uncomfortable submitting their patients to this screening process without using a shared decision-making process. 7 There is now a consensus that patients should have the opportunity to participate in decisions about their health. 8,9 They should understand whether there are options and the related consequences of these options. Patient preferences should be integrated into decision making. 10 Decis...

What do women and healthcare professionals expect of decision aids for breast cancer screening? A qualitative study in France

“…We found that the study participants wanted an easy-to-use, intuitive, interactive, computer-based DA with diagrams and graphics. In a recent systematic review of the quality of DAs developed for women eligible for mammogram screening, the three best-rated dimensions of standard DAs were disclosure (transparency and conflicts of interest), information (the provision of sufficient detail) and outcome probabilities 29. The women and the healthcare professionals interviewed in our study also stated that those three dimensions were important to them.…”

“…In a recent systematic review of the quality of DAs developed for women eligible for mammogram screening, the three best-rated dimensions of standard DAs were disclosure (transparency and conflicts of interest), information (the provision of sufficient detail) and outcome probabilities. 29 The women and the healthcare professionals interviewed in our study also stated that those three dimensions were important to them. We considered that a future DA must focus on all six dimensions, so that women and healthcare professionals engage with the tool.…”

Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older

“…To create the lower health literacy version required removing some of the content recommended for DAs, as determined by the International Patient Decision Aid Standards. 29 For example, to shorten the DA, we removed information on treatments that would likely be offered if breast cancer was found. Future work should evaluate whether all of the components recommended for highquality DAs are needed if their inclusion makes them too challenging for older adults with lower health literacy to understand and/or to use.…”

Primary Care Providers’ Perceptions of the Acceptability, Appropriateness, and Feasibility of a Mammography Decision Aid for Women Aged 75 and Older

“…It is available at ePrognosis.ucsf.edu 12 and was found in an independent review to be high quality based on International Patient DA Standards (IPDAS). 13 In a PCP-clustered randomized clinical trial (RCT) that included 546 women 75 seen by 137 PCPs practicing at 1 of 11 primary care practices (9 in Massachusetts [MA], 2 in North Carolina [NC]), receipt of the DA in the waiting room before a primary care visit led to women 75 being more knowledgeable of mammography's benefits and harms and to 9% fewer women being screened; 87% of women found the DA helpful. 14 The next step is to prepare for DA implementation in practice.…”