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

Abstract

ObjectiveBreast cancer screening decision aids (DAs) are designed to help women decide whether or not to participate in mammography-based programmes. We aimed to explore women’s and healthcare professionals’ expectations of a breast cancer screening DA, as part of the French DEDICACES study.MethodsThis French qualitative study was based on semistructured, individual interviews with women from the general population, general practitioners (GPs), midwives, gynaecologists, radiologists and screening centre managers. Sampling was purposive and used diversification criteria. The inductive analysis was based on grounded theory.ResultsBetween April 2018 and May 2019, we interviewed 40 people: 13 women, 14 GPs, 4 gynaecologists, 3 midwives, 3 radiologists and 3 screening centre managers. The women and the healthcare professionals considered that a DA could help to improve levels of knowledge, harmonise medical practice and provide reliable, comprehensive information. Overall, the interviewees wanted an easy-to-use, intuitive, graphic-rich, interactive, computer-based, patient-centred DA. Use of the DA might be limited by a lack of familiarity with shared decision-making (SDM), the risk of misuse and a preference for asymmetric positive information.ConclusionThe present results are likely to facilitate the development of the first validated tool for SDM support in French breast cancer screening programmes.

Would shared decision-making be useful in breast cancer screening programmes? A qualitative study using focus group discussions to gather evidence from French women with different socioeconomic backgrounds

“…Evidence reported here and in other settings has shown that SDM, notably in cancer prevention, might be difficult to implement due to time constraints in medical practice [ 22 – 25 , 61 , 63 ]. Our results add that it might also be particularly challenging to implement for women from LSE backgrounds.…”

“…For example, in our study women from LSE backgrounds did not report potential risks related to BCS; only one woman from a HSE background mentioned risks related to overdiagnosis and/or overtreatment. This latest result might suggest that risks related to BCS overdiagnosis and/or overtreatment may no longer be salient among women as they were during the controversy in France [ 7 ], even though a French study performed two years prior to our study paints a different picture [ 61 ]. The term “informed choice”, when referring to participation in cancer screening programmes may itself generate anxiety causing the public to question whether health professionals themselves have doubts about the BCS programme [ 60 , 62 ].…”

Development and evaluation of a decision aid for women eligible for organized breast cancer screening according to international standards: A multi-method study

“…1 illustrates the three development stages of this DA. During Stage 1 a prototype was developed from a qualitative study [ 18 ], systematic review [ 16 ] and targeted review. In Stage 2 the prototype was Alpha tested to obtain a first version, which will be Beta tested in Stage 3.…”

“…Scoping for the DA was performed between 2017 and 2019 and included determining the definition and purpose of the DA and its target audience, and performing a qualitative study [ 18 ], a systematic review of existing DAs [ 16 ], and a targeted literature review. Content for the DA prototype was developed from these studies between January 2019 and April 2020.…”

“…The qualitative study conducted between April 2018 and May 2019 among 13 women and 27 healthcare professionals involved in screening (GPs, midwifes, gynacologists, radiologists, screening center managers). It found users expected on-line access, patient appropriate content, ease of use (interactive, intuitive), and graphics [ 18 ].…”