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Smith J, Dodd RH, Wallis KA, Naganathan V, Cvejic E, Jansen J, McCaffery KJ. General practitioners' views and experiences of communicating with older people about cancer screening: a qualitative study. Fam Pract 2024; 41:543-553. [PMID: 36334011 PMCID: PMC11324317 DOI: 10.1093/fampra/cmac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people. AIM To investigate GPs' views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with older people (≥70 years). DESIGN AND SETTING Qualitative, semi-structured interviews, Australia. METHOD Interviews were conducted with GPs practising in Australia (n = 28), recruited through practice-based research networks, primary health networks, social media, and email invitation. Interviews were audio-recorded and analysed thematically using Framework Analysis. RESULTS Findings across GPs were organized into 3 themes: (i) varied motivation to initiate cancer screening discussions; some GPs reported that they only initiated screening within recommended ages (<75 years), others described initiating discussions beyond recommended ages, and some experienced older patient-initiated discussions; (ii) GPs described the role they played in providing screening information, whereby detailed discussions about the benefits/risks of prostate screening were more likely than other nationally funded screening types (breast, cervical, and bowel); however, some GPs had limited knowledge of recommendations and found it challenging to explain why screening recommendations have upper ages; (iii) GPs reported providing tailored advice and discussion based on personal patient preferences, overall health/function, risk of cancer, and previous screening. CONCLUSIONS Strategies to support conversations between GPs and older people about the potential benefits and harms of screening in older age and rationale for upper age limits to screening programmes may be helpful. Further research in this area is needed.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael H Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Katharine A Wallis
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, Concord, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Kirsten J McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Smith J, Cvejic E, Houssami N, Schonberg MA, Vincent W, Naganathan V, Jansen J, Dodd RH, Wallis K, McCaffery KJ. Randomized Trial of Information for Older Women About Cessation of Breast Cancer Screening Invitations. J Gen Intern Med 2024; 39:1332-1341. [PMID: 38409512 PMCID: PMC11169431 DOI: 10.1007/s11606-024-08656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Older women receive no information about why Australia's breast screening program (BreastScreen) invitations cease after 74 years. We tested how providing older women with the rationale for breast screening cessation impacted informed choice (adequate knowledge; screening attitudes aligned with intention). METHODS In a three-arm online randomized trial, eligible participants were females aged 70-74 years who had recently participated in breast screening (within 5 years), without personal breast cancer history, recruited through Qualtrics. Participants read a hypothetical scenario in which they received a BreastScreen letter reporting no abnormalities on their mammogram. They were randomized to receive the letter: (1) without any rationale for screening cessation (control); (2) with screening cessation rationale in printed-text form (e.g., downsides of screening outweigh the benefits after age 74); or (3) with screening cessation rationale presented in an animation video form. The primary outcome was informed choice about continuing/stopping breast screening beyond 74 years. RESULTS A total of 376 participant responses were analyzed. Compared to controls (n = 122), intervention arm participants (text [n = 132] or animation [n = 122]) were more likely to make an informed choice (control 18.0%; text 32.6%, p = .010; animation 40.5%, p < .001). Intervention arm participants had more adequate knowledge (control 23.8%; text 59.8%, p < .001; animation 68.9%, p < .001), lower screening intentions (control 17.2%; text 36.4%, p < .001; animation 49.2%, p < .001), and fewer positive screening attitudes regarding screening for themselves in the animation arm, but not in the text arm (control 65.6%; text 51.5%, p = .023; animation 40.2%, p < .001). CONCLUSIONS Providing information to older women about the rationale for breast cancer screening cessation increased informed decision-making in a hypothetical scenario. This study is an important first step in improving messaging provided by national cancer screening providers direct to older adults. Further research is needed to assess the impact of different elements of the intervention and the impact of providing this information in clinical practice, with more diverse samples. TRIAL REGISTRATION ANZCTRN12623000033640.
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Affiliation(s)
- Jenna Smith
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, NSW, Australia
| | - Mara A Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wendy Vincent
- BreastScreen NSW, Sydney Local Health District, Sydney, NSW, Australia
| | - Vasi Naganathan
- Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia
- Department of Geriatric Medicine, Centre for Education and Research On Ageing, Concord Hospital, Concord, NSW, Australia
| | - Jesse Jansen
- Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Rachael H Dodd
- The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, NSW, Australia
| | - Katharine Wallis
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, QLD, Australia
| | - Kirsten J McCaffery
- Edward Ford Building (A27), The University of Sydney, Sydney, NSW, Australia.
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Dickson-Swift V, Adams J, Spelten E, Blackberry I, Wilson C, Yuen E. Breast cancer screening motivation and behaviours of women aged over 75 years. Psychooncology 2024; 33:e6268. [PMID: 38110243 DOI: 10.1002/pon.6268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE In Australia, breast screening is offered free every two years to women aged 50-74 years. Women aged ≥75 are eligible to receive a free mammogram but do not receive an invitation. This study aimed to explore the motivations and behaviours of women living in Australia aged ≥75 years regarding ongoing breast cancer screening given the public health guidance. METHODS Sixty women aged ≥75 were recruited from metropolitan, regional, and rural areas across Australia to participate in a descriptive qualitative study. Semi-structured interviews were used to seek reflection on women's experience of screening, any advice they had received about screening beyond 75, their understanding of the value of screening and their intention to participate in the future. Thematic analysis of transcripts led to the development of themes. RESULTS Themes resulting from the study included: reasons to continue and discontinue screening, importance of inclusivity in the health system and availability of information. Regular screeners overwhelmingly wished to continue screening and had strong beliefs in the benefits of screening. Women received limited information about the benefits or harms of screening beyond age 75 and very few had discussed screening with their Primary Healthcare Provider. No longer receiving an invitation to attend screening impacted many women's decision-making. CONCLUSION More information via structured discussion with health professionals is required to inform women about the risks and benefits of ongoing screening. No longer being invited to attend screening left many women feeling confused and for some this led to feelings of discrimination.
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Affiliation(s)
- Virginia Dickson-Swift
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Joanne Adams
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Evelien Spelten
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, Melbourne University, Melbourne, Victoria, Australia
- La Trobe University, School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - Eva Yuen
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- La Trobe University, School of Psychology and Public Health, Bundoora, Victoria, Australia
- Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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4
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Anez-Bruzual I, Coughlin S, Clay D, Heiman J, Dungan M, Weber M, Almario CV, Leung G, Ahmad NA, Ginsberg GG, Kochman ML, Valverde KD, Long JM, Katona BW. Assessment of the Psychosocial Impact of Pancreatic Cancer Surveillance in High-Risk Individuals. Cancers (Basel) 2023; 16:86. [PMID: 38201514 PMCID: PMC10777978 DOI: 10.3390/cancers16010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/05/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Pancreatic cancer (PC) surveillance of high-risk individuals (HRIs) downstages PC and improves survival. However, it remains less clear whether PC surveillance has a positive psychosocial impact on HRIs. Herein, we aimed to define the attitudes and beliefs of HRIs undergoing PC surveillance, and the immediate and sustained psychosocial impact of PC surveillance in HRIs. METHODS 100 HRIs undergoing PC surveillance by endoscopic ultrasound (EUS) completed three surveys addressing different components of the psychosocial impact of PC surveillance. Logistic regression analyses were performed to identify predictive factors relating to these components. RESULTS Most HRIs reported increased perceived benefits of PC surveillance, self-efficacy, and perceived severity of PC. HRIs reported few negative emotions prior to surveillance and frequent positive emotions after surveillance. Compared to prior to surveillance, there was a 53.5% decrease in the level of distress reported by HRIs after surveillance, which was sustained for 4-6 weeks post-surveillance. Family history of PC and lower self-reported mental health were identified as predictors for increased perceived susceptibility to PC (p < 0.01) and greater change in distress pre- to post-surveillance (p < 0.01), respectively. CONCLUSIONS Our findings suggest that PC surveillance can lead to sustained psychosocial benefits in HRIs.
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Affiliation(s)
- Isabel Anez-Bruzual
- Master of Science in Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (I.A.-B.); (K.D.V.)
| | - Sarah Coughlin
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Daniel Clay
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Jordan Heiman
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Michaela Dungan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Marina Weber
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Christopher V. Almario
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Galen Leung
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Nuzhat A. Ahmad
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Gregory G. Ginsberg
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Michael L. Kochman
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
| | - Kathleen D. Valverde
- Master of Science in Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (I.A.-B.); (K.D.V.)
| | - Jessica M. Long
- Division of Hematology-Oncology, Department of Medicine, Penn Medicine, Philadelphia, PA 19104, USA;
| | - Bryson W. Katona
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.C.); (D.C.); (J.H.); (M.D.); (M.W.); (G.L.); (N.A.A.); (G.G.G.); (M.L.K.)
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5
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Gram EG, Jønsson ABR, Brodersen JB, Damhus CS. Questioning 'Informed Choice' in Medical Screening: The Role of Neoliberal Rhetoric, Culture, and Social Context. Healthcare (Basel) 2023; 11:healthcare11091230. [PMID: 37174772 PMCID: PMC10178002 DOI: 10.3390/healthcare11091230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Participation in medical screening programs is presented as a voluntary decision that should be based on an informed choice. An informed choice is often emphasized to rely on three assumptions: (1) the decision-maker has available information about the benefits and harms, (2) the decision-maker can understand and interpret this information, and (3) the decision-maker can relate this information to personal values and preferences. In this article, we empirically challenge the concept of informed choice in the context of medical screening. We use document analysis to analyze and build upon findings and interpretations from previously published articles on participation in screening. We find that citizens do not receive neutral or balanced information about benefits and harms, yet are exposed to manipulative framing effects. The citizens have high expectations about the benefits of screening, and therefore experience cognitive strains when informed about the harm. We demonstrate that decisions about screening participation are informed by neoliberal arguments of personal responsibility and cultural healthism, and thus cannot be regarded as decisions based on individual values and preferences independently of context. We argue that the concept of informed choice serves as a power technology for people to govern themselves and can be considered an implicit verification of biopower.
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Affiliation(s)
- Emma Grundtvig Gram
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Primary Health Care Research Unit, 4100 Region Zealand, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Department of People and Technology, Roskilde University, 4000 Roskilde, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, 9019 Tromsø, Norway
| | - John Brandt Brodersen
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Primary Health Care Research Unit, 4100 Region Zealand, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, 9019 Tromsø, Norway
| | - Christina Sadolin Damhus
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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Gram EG, Knudsen SW, Brodersen JB, Jønsson ABR. Women's experiences of age-related discontinuation from mammography screening: A qualitative interview study. Health Expect 2023; 26:1096-1106. [PMID: 36807965 PMCID: PMC10154894 DOI: 10.1111/hex.13723] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/20/2023] Open
Abstract
INTRODUCTION In Denmark, women are discontinued from mammography screening at age 69 due to decreased likelihood of benefits and increased likelihood of harm. The risk of harm increases with age and includes false positives, overdiagnosis and overtreatment. In a questionnaire survey, 24 women expressed unsolicited concerns about being discontinued from mammography screening due to age. This calls for further investigation of experiences related to discontinuation from screening. METHODS We invited the women, who had left comments on the questionnaire, to participate in in-depth interviews with the purpose to explore their reactions, preferences, and conceptions about mammography screening and discontinuation. The interviews lasted 1-4 h and were followed up with a telephone interview 2 weeks after the initial interview. RESULTS The women had high expectations of the benefits of mammography screening and felt that participation was a moral obligation. Following that, they perceived the screening discontinuation as a result of societal age discrimination and consequently felt devalued. Further, the women perceived the discontinuation as a health threat, felt more susceptible to late diagnosis and death, and therefore sought out new ways to control their risk of breast cancer. CONCLUSION Our findings indicate that the age-related discontinuation from mammography screening might be of more importance than previously assumed. This study raises important questions about screening ethics, and we encourage research to explore this in other settings. PATIENT AND PUBLIC CONTRIBUTION This study was conducted as a result of the women's unsolicited concerns about being discontinued from screening. This particular group contributed to the study with their own statements, interpretations and perspectives on the discontinuation of screening, and the initial analysis of data was discussed with the women during follow-up interviews.
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Affiliation(s)
- Emma G Gram
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | - Sigrid W Knudsen
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark.,The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, Tromsø, Norway
| | - Alexandra Brandt R Jønsson
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of People and Technology, Roskilde University, Roskilde, Denmark.,The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, Tromsø, Norway
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Nickel B, Dolan H, Houssami N, Cvejic E, Brennan M, Hersch J, Dorrington M, Verde A, Vaccaro L, McCaffery K. Factors associated with women's supplemental screening intentions following dense breast notification in an online randomised experimental study. J Med Screen 2022; 30:92-95. [PMID: 36071630 DOI: 10.1177/09691413221125320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, School of Public Health, 4334University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, Australia
| | - Hankiz Dolan
- Wiser Healthcare, School of Public Health, 4334University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, School of Public Health, 4334University of Sydney, Sydney, Australia.,The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Erin Cvejic
- Wiser Healthcare, School of Public Health, 4334University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, Australia
| | - Meagan Brennan
- School of Medicine Sydney, 3431University of Notre Dame Australia, Sydney, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Jolyn Hersch
- Wiser Healthcare, School of Public Health, 4334University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, Australia
| | | | - Angela Verde
- 104351Breast Cancer Network Australia, Melbourne, Australia
| | - Lisa Vaccaro
- 430854Health Consumers New South Wales, Sydney, Australia.,Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, School of Public Health, 4334University of Sydney, Sydney, Australia.,Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, Australia
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Laza-Vásquez C, Martínez-Alonso M, Forné-Izquierdo C, Vilaplana-Mayoral J, Cruz-Esteve I, Sánchez-López I, Reñé-Reñé M, Cazorla-Sánchez C, Hernández-Andreu M, Galindo-Ortego G, Llorens-Gabandé M, Pons-Rodríguez A, Rué M. Feasibility and Acceptability of Personalized Breast Cancer Screening (DECIDO Study): A Single-Arm Proof-of-Concept Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10426. [PMID: 36012059 PMCID: PMC9407798 DOI: 10.3390/ijerph191610426] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the acceptability and feasibility of offering risk-based breast cancer screening and its integration into regular clinical practice. A single-arm proof-of-concept trial was conducted with a sample of 387 women aged 40-50 years residing in the city of Lleida (Spain). The study intervention consisted of breast cancer risk estimation, risk communication and screening recommendations, and a follow-up. A polygenic risk score with 83 single nucleotide polymorphisms was used to update the Breast Cancer Surveillance Consortium risk model and estimate the 5-year absolute risk of breast cancer. The women expressed a positive attitude towards varying the frequency of breast screening according to individual risk and, especially, more frequently inviting women at higher-than-average risk. A lower intensity screening for women at lower risk was not as welcome, although half of the participants would accept it. Knowledge of the benefits and harms of breast screening was low, especially with regard to false positives and overdiagnosis. The women expressed a high understanding of individual risk and screening recommendations. The participants' intention to participate in risk-based screening and satisfaction at 1-year were very high.
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Affiliation(s)
- Celmira Laza-Vásquez
- Department of Nursing and Physiotherapy and Health Care Research Group (GRECS), IRBLleida—Institut de Recerca Biomèdica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Martínez-Alonso
- IRBLleida—Institut de Recerca Biomèdica de Lleida, Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
| | - Carles Forné-Izquierdo
- Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
- Heorfy Consulting, 25007 Lleida, Spain
| | - Jordi Vilaplana-Mayoral
- Department of Computing and Industrial Engineering, University of Lleida, 25001 Lleida, Spain
| | - Inés Cruz-Esteve
- Primer de Maig Basic Health Area, Catalan Institute of Health, 25003 Lleida, Spain
| | | | - Mercè Reñé-Reñé
- Department of Radiology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | | | | | | | | | - Anna Pons-Rodríguez
- Example Basic Health Area, Catalan Institute of Health, 25006 Lleida, Spain
- Health PhD Program, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Rué
- IRBLleida—Institut de Recerca Biomèdica de Lleida, Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
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Chen MM, Hughes TM, Dossett LA, Pitt SC. Peace of Mind: A Role in Unnecessary Care? J Clin Oncol 2022; 40:433-437. [PMID: 34882501 PMCID: PMC8824400 DOI: 10.1200/jco.21.01895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michelle M. Chen
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tasha M. Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Susan C. Pitt
- Department of Surgery, University of Wisconsin, Madison, WI
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