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Chengang H, Liping W, Shujin W, Chen C, Jiayue Y, Jingjing L, Shujie H, Jieming W, Liyan Y, Ni Z, Jinhui C, Jiaqi S. Multi-stage optimization strategy based on contextual analysis to create M-health components for case management model in breast cancer transitional care: the CMBM study as an example. BMC Nurs 2024; 23:385. [PMID: 38844982 PMCID: PMC11155158 DOI: 10.1186/s12912-024-02049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/29/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND None of the early M-Health applications are designed for case management care services. This study aims to describe the process of developing a M-health component for the case management model in breast cancer transitional care and to highlight methods for solving the common obstacles faced during the application of M-health nursing service. METHODS We followed a four-step process: (a) Forming a cross-functional interdisciplinary development team containing two sub-teams, one for content development and the other for software development. (b) Applying self-management theory as the theoretical framework to develop the M-health application, using contextual analysis to gain a comprehensive understanding of the case management needs of oncology nursing specialists and the supportive care needs of out-of-hospital breast cancer patients. We validated the preliminary concepts of the framework and functionality of the M-health application through multiple interdisciplinary team discussions. (c) Adopting a multi-stage optimization strategy consisting of three progressive stages: screening, refining, and confirmation to develop and continually improve the WeChat mini-programs. (d) Following the user-centered principle throughout the development process and involving oncology nursing specialists and breast cancer patients at every stage. RESULTS Through a continuous, iterative development process and rigorous testing, we have developed patient-end and nurse-end program for breast cancer case management. The patient-end program contains four functional modules: "Information", "Interaction", "Management", and "My", while the nurse-end program includes three functional modules: "Consultation", "Management", and "My". The patient-end program scored 78.75 on the System Usability Scale and showed a 100% task passing rate, indicating that the programs were easy to use. CONCLUSIONS Based on the contextual analysis, multi-stage optimization strategy, and interdisciplinary team work, a WeChat mini-program has been developed tailored to the requirements of the nurses and patients. This approach leverages the expertise of professionals from multiple disciplines to create effective and evidence-based solutions that can improve patient outcomes and quality of care.
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Affiliation(s)
- Hong Chengang
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Wang Liping
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China.
| | - Wang Shujin
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Chen Chen
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Yang Jiayue
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Lu Jingjing
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Hua Shujie
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Wu Jieming
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Yao Liyan
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Zeng Ni
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Chu Jinhui
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
| | - Sun Jiaqi
- School of Nursing, Hangzhou Normal University, Hangzhou City, Zhejiang Province, 311100, China
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Sgarbossa NJ, Alarcon-Ruiz CA, Kopitowski KS, Franco JV. Shared decision-making for supporting women's decisions about breast cancer screening. Cochrane Database Syst Rev 2024; 5:CD013822. [PMID: 38726892 PMCID: PMC11082933 DOI: 10.1002/14651858.cd013822.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND In breast cancer screening programmes, women may have discussions with a healthcare provider to help them decide whether or not they wish to join the breast cancer screening programme. This process is called shared decision-making (SDM) and involves discussions and decisions based on the evidence and the person's values and preferences. SDM is becoming a recommended approach in clinical guidelines, extending beyond decision aids. However, the overall effect of SDM in women deciding to participate in breast cancer screening remains uncertain. OBJECTIVES To assess the effect of SDM on women's satisfaction, confidence, and knowledge when deciding whether to participate in breast cancer screening. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 8 August 2023. We also screened abstracts from two relevant conferences from 2020 to 2023. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) and cluster-RCTs assessing interventions targeting various components of SDM. The focus was on supporting women aged 40 to 75 at average or above-average risk of breast cancer in their decision to participate in breast cancer screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and conducted data extraction, risk of bias assessment, and GRADE assessment of the certainty of the evidence. Review outcomes included satisfaction with the decision-making process, confidence in the decision made, knowledge of all options, adherence to the chosen option, women's involvement in SDM, woman-clinician communication, and mental health. MAIN RESULTS We identified 19 studies with 64,215 randomised women, mostly with an average to moderate risk of breast cancer. Two studies covered all aspects of SDM; six examined shortened forms of SDM involving communication on risks and personal values; and 11 focused on enhanced communication of risk without other SDM aspects. SDM involving all components compared to control The two eligible studies did not assess satisfaction with the SDM process or confidence in the decision. Based on a single study, SDM showed uncertain effects on participant knowledge regarding the age to start screening (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.61 to 2.28; 133 women; very low certainty evidence) and frequency of testing (RR 0.84, 95% CI 0.68 to 1.04; 133 women; very low certainty evidence). Other review outcomes were not measured. Abbreviated forms of SDM with clarification of values and preferences compared to control Of the six included studies, none evaluated satisfaction with the SDM process. These interventions may reduce conflict in the decision made, based on two measures, Decisional Conflict Scale scores (mean difference (MD) -1.60, 95% CI -4.21 to 0.87; conflict scale from 0 to 100; 4 studies; 1714 women; very low certainty evidence) and the proportion of women with residual conflict compared to control at one to three months' follow-up (rate of women with a conflicted decision, RR 0.75, 95% CI 0.56 to 0.99; 1 study; 1001 women, very low certainty evidence). Knowledge of all options was assessed through knowledge scores and informed choice. The effect of SDM may enhance knowledge (MDs ranged from 0.47 to 1.44 higher scores on a scale from 0 to 10; 5 studies; 2114 women; low certainty evidence) and may lead to higher rates of informed choice (RR 1.24, 95% CI 0.95 to 1.63; 4 studies; 2449 women; low certainty evidence) compared to control at one to three months' follow-up. These interventions may result in little to no difference in anxiety (MD 0.54, 95% -0.96 to 2.14; scale from 20 to 80; 2 studies; 749 women; low certainty evidence) and the number of women with worries about cancer compared to control at four to six weeks' follow-up (RR 0.88, 95% CI 0.73 to 1.06; 1 study, 639 women; low certainty evidence). Other review outcomes were not measured. Enhanced communication about risks without other SDM aspects compared to control Of 11 studies, three did not report relevant outcomes for this review, and none assessed satisfaction with the SDM process. Confidence in the decision made was measured by decisional conflict and anticipated regret of participating in screening or not. These interventions, without addressing values and preferences, may result in lower confidence in the decision compared to regular communication strategies at two weeks' follow-up (MD 2.89, 95% CI -2.35 to 8.14; Decisional Conflict Scale from 0 to 100; 2 studies; 1191 women; low certainty evidence). They may result in higher anticipated regret if participating in screening (MD 0.28, 95% CI 0.15 to 0.41) and lower anticipated regret if not participating in screening (MD -0.28, 95% CI -0.42 to -0.14). These interventions increase knowledge (MD 1.14, 95% CI 0.61 to 1.62; scale from 0 to 10; 4 studies; 2510 women; high certainty evidence), while it is unclear if there is a higher rate of informed choice compared to regular communication strategies at two to four weeks' follow-up (RR 1.27, 95% CI 0.83 to 1.92; 2 studies; 1805 women; low certainty evidence). These interventions result in little to no difference in anxiety (MD 0.33, 95% CI -1.55 to 0.99; scale from 20 to 80) and depression (MD 0.02, 95% CI -0.41 to 0.45; scale from 0 to 21; 2 studies; 1193 women; high certainty evidence) and lower cancer worry compared to control (MD -0.17, 95% CI -0.26 to -0.08; scale from 1 to 4; 1 study; 838 women; high certainty evidence). Other review outcomes were not measured. AUTHORS' CONCLUSIONS Studies using abbreviated forms of SDM and other forms of enhanced communications indicated improvements in knowledge and reduced decisional conflict. However, uncertainty remains about the effect of SDM on supporting women's decisions. Most studies did not evaluate outcomes considered important for this review topic, and those that did measured different concepts. High-quality randomised trials are needed to evaluate SDM in diverse cultural settings with a focus on outcomes such as women's satisfaction with choices aligned to their values.
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Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Victoria Ruiz Yanzi
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadia J Sgarbossa
- Health Department, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Karin S Kopitowski
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Va Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Kamil D, Wojcik KM, Smith L, Zhang J, Wilson OWA, Butera G, Jayasekera J. A Scoping Review of Personalized, Interactive, Web-Based Clinical Decision Tools Available for Breast Cancer Prevention and Screening in the United States. MDM Policy Pract 2024; 9:23814683241236511. [PMID: 38500600 PMCID: PMC10946080 DOI: 10.1177/23814683241236511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/04/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction. Personalized web-based clinical decision tools for breast cancer prevention and screening could address knowledge gaps, enhance patient autonomy in shared decision-making, and promote equitable care. The purpose of this review was to present evidence on the availability, usability, feasibility, acceptability, quality, and uptake of breast cancer prevention and screening tools to support their integration into clinical care. Methods. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to conduct this review. We searched 6 databases to identify literature on the development, validation, usability, feasibility, acceptability testing, and uptake of the tools into practice settings. Quality assessment for each tool was conducted using the International Patient Decision Aid Standard instrument, with quality scores ranging from 0 to 63 (lowest-highest). Results. We identified 10 tools for breast cancer prevention and 9 tools for screening. The tools included individual (e.g., age), clinical (e.g., genomic risk factors), and health behavior (e.g., alcohol use) characteristics. Fourteen tools included race/ethnicity, but no tool incorporated contextual factors (e.g., insurance, access) associated with breast cancer. All tools were internally or externally validated. Six tools had undergone usability testing in samples including White (median, 71%; range, 9%-96%), insured (99%; 97%-100%) women, with college education or higher (60%; 27%-100%). All of the tools were developed and tested in academic settings. Seven (37%) tools showed potential evidence of uptake in clinical practice. The tools had an average quality assessment score of 21 (range, 9-39). Conclusions. There is limited evidence on testing and uptake of breast cancer prevention and screening tools in diverse clinical settings. The development, testing, and integration of tools in academic and nonacademic settings could potentially improve uptake and equitable access to these tools. Highlights There were 19 personalized, interactive, Web-based decision tools for breast cancer prevention and screening.Breast cancer outcomes were personalized based on individual clinical characteristics (e.g., age, medical history), genomic risk factors (e.g., BRCA1/2), race and ethnicity, and health behaviors (e.g., smoking). The tools did not include contextual factors (e.g., insurance status, access to screening facilities) that could potentially contribute to breast cancer outcomes.Validation, usability, acceptability, and feasibility testing were conducted mostly among White and/or insured patients with some college education (or higher) in academic settings. There was limited evidence on testing and uptake of the tools in nonacademic clinical settings.
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Affiliation(s)
- Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M. Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Laney Smith
- Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | | | - Oliver W. A. Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Herrera DJ, van de Veerdonk W, Berhe NM, Talboom S, van Loo M, Alejos AR, Ferrari A, Van Hal G. Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening. Cancers (Basel) 2023; 15:3867. [PMID: 37568683 PMCID: PMC10417450 DOI: 10.3390/cancers15153867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians' and vulnerable populations' preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients' values. Considering the complexities of patients' and clinicians' preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.
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Affiliation(s)
- Deborah Jael Herrera
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Wessel van de Veerdonk
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Neamin M Berhe
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Société Générale de Surveillance (SGS), 2800 Mechelen, Belgium
| | - Sarah Talboom
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Marlon van Loo
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Andrea Ruiz Alejos
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Allegra Ferrari
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16123 Genoa, Italy
| | - Guido Van Hal
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
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López-Panisello MB, Pérez-Lacasta MJ, Rué M, Carles-Lavila M. Factors influencing intention to participate in breast cancer screening. An exploratory structural model. PLoS One 2023; 18:e0281454. [PMID: 36735750 PMCID: PMC9897558 DOI: 10.1371/journal.pone.0281454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/26/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The paper has two objectives. The first one examines whether informing women about the benefits and adverse effects of breast cancer screening could have an effect on three variables: their knowledge, the importance women attach to the future consequences of their current decisions (time perspective), and the degree to which women are worried about developing breast cancer (worry). The second one examines whether these three variables affect their intention to participate in the screening, either directly or indirectly through their feeling of regret if they do not attend the screening (anticipated regret); through their values and the support they receive in making their decisions (decisional conflict); and, through the perceived acceptability and benefits of the screening programme (attitude). METHODS Partial least squares-structural equation modelling (PLS-SEM) is used to analyse both objectives and to differentiate between direct, indirect, and moderating effects, due to the incorporation in the model of the three mediating variables (anticipated regret, decisional conflict, and attitude) and a moderating variable (educational level). RESULTS Information affects knowledge (objective variable), but not the behavioural variables (time perspective and worry). On the other hand, the level of knowledge has no direct or indirect effect on intention, but behavioural variables do affect it through the mediating variables. CONCLUSIONS The variables of the planned behaviour theory are relevant to understand women's decisions and to be able to take appropriate health policy measures. Doing so, the processes of personalised screening would improve, or there would be the incorporation of shared decision-making in this context; these being demands associated with the most recent goals achieved in health programmes in many countries.
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Affiliation(s)
- María Belén López-Panisello
- Department of Business Management, Rovira i Virgili University, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| | - María José Pérez-Lacasta
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Research Centre on Economics and Sustainability (ECO-SOS), Reus, Spain
| | - Montserrat Rué
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
- Lleida Biomedical Research Institute (IRBLLEIDA), Lleida, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Misericòrdia Carles-Lavila
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Research Centre on Economics and Sustainability (ECO-SOS), Reus, Spain
- * E-mail:
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Alabdullatif N, Arrieta A, Dlugasch L, Hu N. The Impact of IT-Based Healthcare Communication on Mammography Screening Utilization among Women in the United States: National Health Interview Survey (2011-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12737. [PMID: 36232036 PMCID: PMC9566602 DOI: 10.3390/ijerph191912737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Effective patient-provider communication improves mammography utilization. Using information technology (IT) promotes health outcomes. However, there are disparities in access to IT that could contribute to disparities in mammography utilization. This study aims to assess the association between IT-based health care communication and mammography utilization and to evaluate if this effect is modified by race/ethnicity and age. To this end, this study was conducted using the National Health Interview Survey from 2011 to 2018. A total of 94,290 women aged 40 years and older were included. Multiple logistic regression models were used, and odds ratios were reported. The study found that all IT-based healthcare communication strategies were significantly associated with mammography utilization in all years from 2011 to 2018. In 2018, women who looked up health information on the internet, scheduled a medical appointment on the internet, and communicated with providers by email had a significantly higher chance to use mammography (p ≤ 0.005 for all strategies across all years). White women and women aged 50 years and older benefited the most from IT-based healthcare communication. In conclusion, facilitating access to IT may help increase mammography utilization, which may contribute to eliminating disparities in breast cancer mortality.
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Affiliation(s)
- Noof Alabdullatif
- Department of Health Policy and Management, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
| | - Alejandro Arrieta
- Department of Health Policy and Management, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
| | - Lucie Dlugasch
- Department of Graduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA
| | - Nan Hu
- Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
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Schliemann D, Tan MM, Hoe WMK, Mohan D, Taib NA, Donnelly M, Su TT. mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews. J Med Internet Res 2022; 24:e36316. [PMID: 35969450 PMCID: PMC9425170 DOI: 10.2196/36316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival. OBJECTIVE The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening. METHODS The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review. RESULTS Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth. CONCLUSIONS mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Min Min Tan
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia.,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Wilfred Mok Kok Hoe
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia.,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Tin Tin Su
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia.,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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Laryionava K, Schildmann J, Wensing M, Wedding U, Surmann B, Woydack L, Krug K, Winkler E. Development and Evaluation of a Decision Aid to Support Patients' Participatory Decision-Making for Tumor-Specific and Palliative Therapy for Advanced Cancer: Protocol for a Pre-Post Study. JMIR Res Protoc 2021; 10:e24954. [PMID: 34533464 PMCID: PMC8486990 DOI: 10.2196/24954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background To support advanced cancer patients and their oncologists in therapeutic decisions, we aim to develop a decision aid (DA) in a multiphased, bicentric study. The DA aims to help patients to better understand risks and benefits of the available treatment options including the options of standard palliative care or cancer-specific treatment (ie, off-label drug use within an individual treatment plan). Objective This study protocol outlines the development and testing of the DA in a pre-post study targeting a heterogeneous population of advanced cancer patients. Methods In the first step, we will assess patients’ information and decisional needs as well as the views of the health care providers regarding the content and implementation of the DA. Through a scoping review, we aim to analyze specific characteristics of the decision-making process and to specify the treatment options, outcomes, and probabilities. An interdisciplinary research group of experts will develop and review the DA. In the second step, testing of the DA (design and field testing) with patients and oncologists will be conducted. As a last step, we will run a pre-post design study with 70 doctor-patient encounters to assess improvements on the primary study outcome: patients’ level of decisional conflict. In addition, the user acceptance of all involved parties will be tested. Results Interviews with cancer patients, oncologists, and health care providers (ie, nurses, nutritionists) as well as a literature review from phase I have been completed. The field testing is scheduled for April 2021 to August 2021, with the final revision scheduled for September 2021. The pre-post study of the DA and acceptance testing are scheduled to start in October 2021 and shall be finished in September 2022. Conclusions A unique feature of this study is the development of a DA for patients with different types of advanced cancer, which covers a wide range of topics relevant for patients near the end of life such as forgoing cancer-specific therapy and switching to best supportive care. Trial Registration ClinicalTrials.gov NCT04606238; https://clinicaltrials.gov/ct2/show/NCT04606238. International Registered Report Identifier (IRRID) DERR1-10.2196/24954
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Affiliation(s)
- Katsiaryna Laryionava
- Institute for History and Ethics of Medicine, Centre for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Centre for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Ullrich Wedding
- Palliative Care, Department of Internal Medicine II, University of Jena, Jena, Germany
| | - Bastian Surmann
- Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany
| | - Lena Woydack
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva Winkler
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
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9
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DuBenske L, Ovsepyan V, Little T, Schrager S, Burnside E. Preliminary Evaluation of a Breast Cancer Screening Shared Decision-Making Aid Utilized Within the Primary Care Clinical Encounter. J Patient Exp 2021; 8:23743735211034039. [PMID: 34377770 PMCID: PMC8326620 DOI: 10.1177/23743735211034039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: The US Preventative Services Task Force recommends shared decision-making (SDM) between women aged 40 and 49 years and their physician regarding timing of mammography screening. This preliminary study evaluates women’s and physician’s satisfaction using Breast Cancer Risk Estimator & Decision Aid (BCARE-DA), a shared decision aid utilized during the clinical encounter, and examines SDM quality for these encounters. Methods: Fifty-three women and their physician utilized BCARE-DA and completed surveys measuring satisfaction with Likert-type and open-ended items and women completed the Decision Conflict Scale. Clinic visit transcripts were evaluated for SDM quality using Observer OPTION-5 and Breast Cancer Screening Decision Core Components Checklist. Results: Women and physicians positively evaluated BCARE-DA. Women had low decision conflict. Physicians demonstrated moderate effort toward SDM, greatest in offering options, and lowest for team talk. Physicians demonstrated 2/3 of core SDM elements in 80% to 100% of encounters. Conclusion: Preliminary findings suggest specific promise for such Decision Aids to facilitate SDM through understanding of personal risks for breast cancer formulated within each screening option, while some SDM elements likely require additional facilitating.
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Affiliation(s)
- Lori DuBenske
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Viktoriya Ovsepyan
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Terry Little
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Sarina Schrager
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
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10
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Cadet T, Aliberti G, Karamourtopoulos M, Jacobson A, Siska M, Schonberg MA. Modifying a Mammography Decision Aid for Older Adult Women with Risk Factors for Low Health Literacy. Health Lit Res Pract 2021; 5:e78-e90. [PMID: 34213995 PMCID: PMC8082954 DOI: 10.3928/24748307-20210308-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Guidelines recommend that before being offered mammography screening, women age 75 years and older be informed of the uncertainty of benefit and potential for harm (e.g., being diagnosed with a breast cancer that would otherwise never have shown up in one's lifetime); however, few older women are informed of the risks of mammography screening and most overestimate its benefits. Objective: The aim of this study was to learn from women older than age 75 years who have predisposing risk factors for low health literacy (LHL) how they make decisions about mammography screening, whether an existing decision aid (DA) on mammography screening for them was acceptable and helpful, and suggestions for improving the DA. Methods: We conducted semi-structured interviews with 18 women who were between ages 75 and 89 years and had predisposing risk factors for LHL (i.e., answered somewhat to not at all confident to the health literacy screening question “How confident are you filling out medical forms by yourself?” and/or had an education level of some college or less). Key Results: Findings indicate that women in this study lacked knowledge and understanding that one can decide on mammography screening based on their personal values. Women were enthusiastic about screening based on an interest in taking care of themselves but rely on their providers for health care decisions. Overall, most women found the DA helpful and would recommend the use of the DA. Conclusions: Findings from this study provide formative data to test the efficacy of the modified DA in practice. Failing to consider the informational needs of adults with LHL in design of DAs could inadvertently exacerbate existing inequalities in health. It is essential that DAs consider older women's diverse backgrounds and educational levels to support their decision-making. [HLRP: Health Literacy Research and Practice. 2021;5(2):e78–e90.] Plain Language Summary: The goal of this research was to understand how women older than age 75 years with risk factors for low health literacy made decisions about getting mammograms, whether an educational pamphlet was helpful, and suggestions for improving it. This research helps in understanding how to involve this population in the process of designing patient-related materials for mammogram decision-making.
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Affiliation(s)
- Tamara Cadet
- Address correspondence to Tamara Cadet, PhD, MSW, MPH, Simmons University College of Social Sciences and Policy Practice, School of Social Work, 300 The Fenway, Boston, MA 02115;
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11
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Esmaeili M, Ayyoubzadeh SM, Javanmard Z, R Niakan Kalhori S. A systematic review of decision aids for mammography screening: Focus on outcomes and characteristics. Int J Med Inform 2021; 149:104406. [PMID: 33640838 DOI: 10.1016/j.ijmedinf.2021.104406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Decision Aid systems (DAs) provide information on the pros and cons of mammography. This study aimed to review the research on mammography DAs, synthesize the findings related to their outcomes and characteristics, and address the existed research gap. METHODS Relevant studies were identified through a comprehensive search on some e-databases, including PubMed, EMBASE, Scopus, and Web of Science in August 2020; by searching the keywords of "Breast cancer", "Screening", and "Decision aid systems" as well as their synonyms in the titles and abstracts of the papers with no time limits. Among the selected English journal papers with the interventional study design, those measuring outcome values of using mammography DAs were recognized as eligible for being included in this review. RESULTS The systematic search results in 16 DAs regarding mammography that were designed and then evaluated from 18 selected studies. The results showed that DAs provide improvements in knowledge and informed choice, the decreased decisional conflicts and decisional confidence, almost without changing any attitude towards mammography, mammography participation rates, psychological issues, anticipated regret, and perceived risk of breast cancer. The DAs' effects on women's inclination to screening were divergent. In other words, the DAs affect individuals' inclination in rare cases; however, on occasion, they could affect women's decision to undergo screening. CONCLUSION DAs could correct the bias attached to the existing knowledge on mammography and breast cancer in women so that they are more likely to make a precise decision. Additionally, it might be of central importance in shared decision-making and assisting health providers, in order to promote the quality of care. Accordingly, performing more studies is needed to develop more professional DAs in various countries with different facilities, cultures, and languages.
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Affiliation(s)
- Marzieh Esmaeili
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zohreh Javanmard
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Information Technology, Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand, Iran.
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Kopitowski KS, Franco JVA. Shared decision making for supporting women’s decisions about breast cancer screening. Hippokratia 2020. [DOI: 10.1002/14651858.cd013822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - M. Victoria Ruiz Yanzi
- Family and Community Medicine; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | | | - Karin S Kopitowski
- Family and Community Medicine Division; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Juan VA Franco
- Associate Cochrane Centre; Instituto Universitario Hospital Italiano de Buenos Aires; Buenos Aires Argentina
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13
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Yu L, Li P, Yang S, Guo P, Zhang X, Liu N, Wang J, Zhang W. Web-based decision aids to support breast cancer screening decisions: systematic review and meta-analysis. J Comp Eff Res 2020; 9:985-1002. [PMID: 33025800 DOI: 10.2217/cer-2020-0052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: Breast cancer is a leading cause of cancer among women. Because guidelines on screening for breast cancer for certain ages are controversial, many experts advocate the use of shared decision making (SDM) using validated decision aids (DAs). Recent studies have concluded that DAs are beneficial; however, the results have great heterogeneity. Therefore, further studies are needed to improve understanding of these tools. Objective: This systematic review and meta-analysis aimed to investigate the impact of using web-based DAs in women aged 50 years and below facing the decision to be screened for breast cancer in comparison with usual care. Methods: PubMed, Web of Science, Embase and the Cochrane CENTRAL databases were searched up to February 2020 for studies assessing web-based DAs for women making a breast cancer screening decision and reported quality of decision-making outcomes. Using a random-effects model or a fixed-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD) and relative risks (RR). Results: Of 1097 unique citations, three randomized controlled trials and two before-after studies met the study eligibility criteria. Compared with usual care, web-based DAs increased knowledge (SMD = 0.69; 95% CI: 0.57-0.80; p < 0.00001), reduced decision conflict and increased the proportion of women who made an informed choice (RR = 1.86; 95% CI: 1.38 to 2.50; p < 0.0001), but did not change the intention of women deciding to be screened or affect decision regret. Conclusion: This analysis showed the positive effect of web-based DAs on patient-centered outcomes in breast cancer screening. In the future, more internet devices and free or larger discount WI-FI should be established to ensure more women can benefit from this effective tool.
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Affiliation(s)
- Lin Yu
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Ping Li
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Shu Yang
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Pingping Guo
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Xuehui Zhang
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Na Liu
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Jie Wang
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, School of Nursing, Jilin University, Changchun, Jilin Province, China
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14
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Yang EF, Shah DV, Burnside ES, Little TA, Garino N, Campbell CE. Framing the Clinical Encounter: Shared Decision-Making, Mammography Screening, and Decision Satisfaction. JOURNAL OF HEALTH COMMUNICATION 2020; 25:681-691. [PMID: 33111640 PMCID: PMC7772277 DOI: 10.1080/10810730.2020.1838003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The study examines whether physicians' framing of clinical interactions is related to patient shared decision-making (SDM) satisfaction when using a clinical decision support tool (CDST) concerning mammographic screening. To answer this question, we combined (a) system log data from a CDST, (b) content coding of the physicians' message framing while using the CDST, and (c) a post-visit patient survey to assess SDM satisfaction concerning screening mammography. Results suggest that two types of message frames - consequence frames and numerical frames - moderated the relationship of the CDST on SDM satisfaction. When the CDST displayed low risk of breast cancer for a patient, physicians were able to improve the cognitive aspects of SDM satisfaction by framing the consequences of mammography screening in positive terms. However, when the physician delivered the numerical information in relative, rather than absolute terms, the patient's SDM satisfaction was reduced. Our study advances previous message framing effect research in health communication from experimental settings to clinical encounters. It also discusses the importance of delivering risk-congruent frames in clinical settings.
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Affiliation(s)
- Ellie F Yang
- School of Journalism and Mass Communication, UW-Madison , Madison, WI, USA
| | - Dhavan V Shah
- School of Journalism and Mass Communication, UW-Madison , Madison, WI, USA
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15
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A Pre-Test-Post-Test Trial of a Breast Cancer Risk Report for Women in Their 40s. Am J Prev Med 2020; 59:343-354. [PMID: 32828322 DOI: 10.1016/j.amepre.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/31/2020] [Accepted: 04/05/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Guidelines recommend individualized breast cancer screening and prevention interventions for women in their 40s. Yet, few primary care clinicians assess breast cancer risk. STUDY DESIGN Pretest-Posttest trial. SETTING/PARTICIPANTS Women aged 40-49 years were recruited from one large Boston-based academic primary care practice between July 2017 and April 2019. INTERVENTION Participants completed a pretest, received a personalized breast cancer risk report, saw their primary care clinician, and completed a posttest. MAIN OUTCOME MEASURES Using mixed effects models, changes in screening intentions (0-100 scale [0=will not screen to 100=will screen]), mammography knowledge, decisional conflict, and receipt of screening were examined. Analyses were conducted from June 2019 to February 2020. RESULTS Patient (n=337) mean age was 44.1 (SD=2.9) years, 61.4% were non-Hispanic white, and 76.6% were college graduates; 306 (90.5%) completed follow-up (203 with 5-year breast cancer risk <1.1%). Screening intentions declined from pre- to post-visit (79.3 to 68.0, p<0.0001), especially for women with 5-year risk <1.1% (77.2 to 63.3, p<0.0001), but still favored screening. In the 2 years prior, 37.6% had screening mammography compared with 41.8% over a mean 16 months follow-up (p=0.17). Mammography knowledge increased and decisional conflict declined. Eleven (3.3%) women met criteria for breast cancer prevention medications (ten discussed medications with their clinicians), 22 (6.5%) for MRI (19 discussed MRI with their clinician), and 67 (19.8%) for genetic counseling (47 discussed with the clinician). CONCLUSIONS Receipt of a personalized breast cancer report was associated with women in their 40s making more-informed and less-conflicted mammography screening decisions and with high-risk women discussing breast cancer prevention interventions with clinicians. TRIAL REGISTRATION This study is registered at www.clinicaltrials.govNCT03180086.
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16
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Smith J, Dodd RH, Hersch J, Cvejic E, McCaffery K, Jansen J. Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia. BMJ Open 2020; 10:e034061. [PMID: 32532766 PMCID: PMC7295415 DOI: 10.1136/bmjopen-2019-034061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess different strategies for communicating to older adults about stopping cancer screening. DESIGN 4 (recommendation statement about stopping screening)×(2; time) online survey-based randomised controlled trial. SETTING Australia. PARTICIPANTS 271 English-speaking participants, aged 65-90, screened for breast/prostate cancer at least once in past decade. INTERVENTIONS Time 1: participants read a scenario in which their general practitioner (GP) informed them about the potential benefits and harms of cancer screening, followed by double-blinded randomisation to one of four recommendation statements to stop screening: control ('this screening test would harm you more than benefit you'), health status ('your other health issues should take priority'), life expectancy framed positively ('this test would not help you live longer') and negatively ('you may not live long enough to benefit'). Time 2: in a follow-up scenario, the GP explained why guidelines changed over time (anchoring bias intervention). MEASURES Primary outcomes: screening intention and cancer anxiety (10-point scale, higher=greater intention/anxiety), measured at both time points. SECONDARY OUTCOMES trust (in their GP, the information provided, the Australian healthcare system), decisional conflict and knowledge of the information presented. RESULTS 271 participants' responses analysed. No main effects were found. However, screening intention was lower for the negatively framed life expectancy versus health status statement (6.0 vs 7.1, mean difference (MD)=1.1, p=0.049, 95% CI 0.0 to 2.2) in post hoc analyses. Cancer anxiety was lower for the negatively versus positively framed life expectancy statement (4.8 vs 5.8, MD=1.0, p=0.025, 95% CI 0.1 to 1.9). The anchoring bias intervention reduced screening intention (MD=0.8, p=0.044, 95% CI 0.6 to 1.0) and cancer anxiety (MD=0.3, p=0.002, 95% CI 0.1 to 0.4) across all conditions. CONCLUSION Older adults may reduce their screening intention without reporting increased cancer anxiety when clinicians use a more confronting strategy communicating they may not live long enough to benefit and add an explicit explanation why the recommendation has changed. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618001306202; Results).
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Affiliation(s)
- Jenna Smith
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Jansen
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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17
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Hild S, Johanet M, Valenza A, Thabaud M, Laforest F, Ferrat E, Rat C. 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. Cancer 2020; 126:2765-2774. [PMID: 32267546 DOI: 10.1002/cncr.32858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
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 double-blind 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.
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Affiliation(s)
- Sandrine Hild
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Marion Johanet
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Anna Valenza
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Maïna Thabaud
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Flore Laforest
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Emilie Ferrat
- Primary Care Department, Faculty of Medicine, University of Paris-East Creteil, Creteil, France.,Clinical Epidemiology and Ageing Unit, University of Paris-Est Creteil, Creteil, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
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18
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Eden KB, Ivlev I, Bensching KL, Franta G, Hersh AR, Case J, Fu R, Nelson HD. Use of an Online Breast Cancer Risk Assessment and Patient Decision Aid in Primary Care Practices. J Womens Health (Larchmt) 2020; 29:763-769. [PMID: 32159424 DOI: 10.1089/jwh.2019.8143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: U.S. Preventive Services Task Force (USPSTF) recommendations for mammography screening, genetic counseling and testing for pathogenic BRCA1/2 mutations, and use of risk-reducing medications require assessment of breast cancer risk for clinical decision-making, but efficient methods for risk assessment in clinical practice are lacking. Materials and Methods: A cross-sectional study evaluating a web-based breast cancer risk assessment and decision aid (MammoScreen) was conducted in an academic general internal medicine clinic. All eligible women, 40-74 years of age without previous diagnosis of breast or ovarian cancer and who were enrolled in the Epic MyChart patient portal were invited. MammoScreen uptake and completion rates and consistency between breast cancer risk determined by MammoScreen and existing risk information in the Epic record were measured. Patient and physician experiences were summarized from interviews. Results: Of 448 invited participants, 339 (75.7%) read their MyChart invitation and 125 (36.9%) who read invitations enrolled in the study; 118 (94.4% of enrolled) completed MammoScreen. Twenty-one women were categorized as above-average risk from either MammoScreen data or the chart review and 7 (33.3%) were identified by both sources. Physicians and patients believed MammoScreen was easy to use and was helpful in identifying risks and facilitating shared decision-making. Conclusions: Breast cancer risk assessment and mammography screening decision support were efficiently implemented through a web-based tool for patients sent through an electronic patient portal. Integration of patient decision aids with risk algorithms in clinical practice may help support the implementation of USPSTF recommendations that include risk assessment and shared decision-making.
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Affiliation(s)
- Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Ilya Ivlev
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.,Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Gabriel Franta
- School of Medicine, Oregon Health and Science University, Portland, Oregon.,School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Alyssa R Hersh
- School of Medicine, Oregon Health and Science University, Portland, Oregon.,School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - James Case
- Mongoose Projects, Inc., Corvallis, Oregon
| | - Rongwei Fu
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.,School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Heidi D Nelson
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.,Department of Medicine, Oregon Health and Science University, Portland, Oregon
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Therkildsen SB, Hansen LH, Jensen LED, Finderup J. A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study. JMIR Form Res 2019; 3:e13786. [PMID: 31750836 PMCID: PMC6914284 DOI: 10.2196/13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. OBJECTIVE The aim of this study was to uncover the applicability of the DG as a PDA. METHODS The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. RESULTS A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. CONCLUSIONS The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents' average age. Thus, the applicability of the DG cannot be definitively determined.
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Affiliation(s)
| | | | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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20
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Houghton LC, Howland RE, McDonald JA. Mobilizing Breast Cancer Prevention Research Through Smartphone Apps: A Systematic Review of the Literature. Front Public Health 2019; 7:298. [PMID: 31781525 PMCID: PMC6851054 DOI: 10.3389/fpubh.2019.00298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Breast cancer rates have been increasing worldwide, particularly among young women, suggesting important interactions between genes and health behaviors. At the same time, mobile technology, including smartphones applications (apps), has emerged as a new tool for delivering healthcare and health-related services. As of 2018, there were nearly 600 publicly available breast cancer apps designed to provide disease and treatment information, to manage disease, and to raise overall awareness. However, the extent to which apps are incorporated into breast cancer prevention research is unknown. Therefore, the objective of this review was to determine how mobile applications are being used for breast cancer prevention among women across the cancer control continuum. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed and Web of Science Core Collection databases using the keywords breast cancer, smartphone, mobile application, and phone app. Full-length journal articles available in English that addressed the research question were included. We categorized articles by prevention type (primary, secondary, and tertiary) and phase of research (protocol, development, feasibility, pilot, measurement, and effectiveness), and identified common themes and gaps. Results: Our search yielded 82 studies (69 unique) that used apps in breast cancer prevention research across 20 countries. Approximately half of the named apps were publicly available. The majority (73%) of studies targeted tertiary prevention; 15% targeted secondary and 13% targeted primary prevention. Apps were used across all phases of research with the predominant phase being feasibility in tertiary prevention (34%), effectiveness in secondary prevention (63%), and development (30%) and effectiveness (30%) in primary prevention. Common uses included assessing outcomes relevant to clinical care coordination, quality of life, increasing self-efficacy and screening behaviors, and tracking and managing health behaviors. Conclusions: We identified the following gaps: few effectiveness studies in tertiary prevention, minimal use of apps for breast cancer etiology or early detection, and few interventions in those at average risk of breast cancer. These findings suggest that while mobile apps can inform breast cancer prevention across the continuum, more work is needed to incorporate apps into primary prevention.
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Affiliation(s)
- Lauren C. Houghton
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
| | - Renata E. Howland
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Jasmine A. McDonald
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
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Jongerius C, Russo S, Mazzocco K, Pravettoni G. Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10930. [PMID: 30741644 PMCID: PMC6388100 DOI: 10.2196/10930] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/20/2018] [Accepted: 10/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. OBJECTIVE The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. METHODS A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions' features, outcome measures, and results. RESULTS We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. CONCLUSIONS Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations.
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Affiliation(s)
- Chiara Jongerius
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Selena Russo
- Kids Cancer Centre, Sydney Children's Hospital, University of New South Wales, Sydney, Australia
| | - Ketti Mazzocco
- Department of Oncology and Hemato-oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Schapira MM, Hubbard RA, Seitz HH, Conant EF, Schnall M, Cappella JN, Harrington T, Inge C, Armstrong K. The Impact of a Risk-Based Breast Cancer Screening Decision Aid on Initiation of Mammography Among Younger Women: Report of a Randomized Trial. MDM Policy Pract 2019; 4:2381468318812889. [PMID: 30729166 PMCID: PMC6350139 DOI: 10.1177/2381468318812889] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023] Open
Abstract
Background. Guidelines recommend that initiation of breast cancer
screening (BCS) among women aged 40 to 49 years include a shared decision-making
process. The objective of this study is to evaluate the effect of a breast
cancer screening patient decision-aid (BCS-PtDA) on the strength of the
relationship between individual risk and the decision to initiate BCS,
knowledge, and decisional conflict. Methods. We conducted a
randomized clinical trial of a BCS-PtDA that included individual risk estimates
compared with usual care. Participants were women 39 to 48 years of age with no
previous mammogram. Primary outcomes were strength of association between breast
cancer risk and mammography uptake at 12 months, knowledge, and decisional
conflict. Results. Of 204 participants, 65% were Black, the median
age (interquartile range [IQR]) was 40.0 years (39.0–42.0), and median (IQR)
breast cancer lifetime risk was 9.7% (9.2–11.1). Women who received mammography
at 12 months had higher breast cancer lifetime risk than women who had not in
both intervention (mean, 95% CI): 12.2% (10.8–13.6) versus 10.5% (9.8–11.2),
P = 0.04, and control groups: 11.8% (10.4–13.1) versus 9.9%
(9.2–10.6), P = 0.02. However, there was no difference between
groups in the strength of association between mammography uptake and breast
cancer risk (P = 0.87). Follow-up knowledge (0–5) was greater
in the intervention versus control group (mean, 95% CI): 3.84 (3.5–4.2) versus
3.17 (2.8–3.5), P = 0.01. There was no change in decisional
conflict score (1–100) between the intervention versus control group (mean, 95%
CI): 24.8 (19.5–30.2) versus 32.4 (25.9–39.0), P = 0.07.
Conclusions. The BCS-PtDA improved knowledge but did not affect
risk-based decision making regarding age of initiation of BCS. These findings
indicate the complexity of changing behaviors to incorporate objective risk in
the medical decision-making process.
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Affiliation(s)
| | - Rebecca A Hubbard
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Holli H Seitz
- Department of Communication, Social Science Research Center, Mississippi State University, Starkville, Mississippi
| | | | | | - Joseph N Cappella
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Carrie Inge
- Department of Medicine, Perelman School of Medicine
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Pacyna JE, Radecki Breitkopf C, Jenkins SM, Sutton EJ, Horrow C, Kullo IJ, Sharp RR. Should pretest genetic counselling be required for patients pursuing genomic sequencing? Results from a survey of participants in a large genomic implementation study. J Med Genet 2018; 56:317-324. [PMID: 30580287 DOI: 10.1136/jmedgenet-2018-105577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE We assessed the decision-making of individuals pursuing genomic sequencing without a requirement for pretest genetic counselling. We sought to describe the extent to which individuals who decline genetic counselling reported decisional conflict or struggled to make a decision to pursue genomic testing. METHODS We administered a 100-item survey to 3037 individuals who consented to the Return of Actionable Variants Empirical study, a genomic medicine implementation study supported by the National Institutes of Health (USA) eMERGE consortium. The primary outcomes of interest were self-reported decisional conflict about the decision to participate in the study and time required to reach a decision. RESULTS We received 2895 completed surveys (response rate=95.3%), and of these respondents 97.8% completed the decisional conflict scale in its entirety. A majority of individuals (63%) had minimal or no decisional conflict about the pursuit of genomic sequencing and were able to reach a decision quickly (78%). Multivariable logistic regression analyses identified several characteristics associated with decisional conflict, including lower education, lower health literacy, lower self-efficacy in coping, lack of prior experience with genetic testing, not discussing study participation with a family member or friend, and being male. CONCLUSION As genomic sequencing is used more widely, genetic counselling resources may not be sufficient to meet demand. Our results challenge the notion that all individuals need genetic counselling in order to make an informed decision about genomic sequencing.
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Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sarah M Jenkins
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Horrow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Dépistage et information des femmes au Canada : comment augmenter les taux de participation pour obtenir la meilleure efficacité du dépistage du cancer du sein ? IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ager B, Jansen J, Porter D, Phillips KA, Glassey R, Butow P. Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy. Breast 2018; 40:156-164. [PMID: 29857282 DOI: 10.1016/j.breast.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/23/2018] [Accepted: 05/18/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). METHODS The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. RESULTS Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. CONCLUSION The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. PRACTICE IMPLICATIONS Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions.
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Affiliation(s)
- B Ager
- School of Psychology, The University of Sydney, Australia
| | - J Jansen
- Sydney Medical School, The University of Sydney, Australia; Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Australia
| | - D Porter
- Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - K A Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - R Glassey
- Medical School, The University of Western Australia, Perth, Australia
| | | | - P Butow
- Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Australia; Centre for Medical Psychology and Evidence Based Decision-Making, The University of Sydney, Australia.
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Does a decision aid improve informed choice in mammography screening? Results from a randomised controlled trial. PLoS One 2017; 12:e0189148. [PMID: 29236722 PMCID: PMC5728514 DOI: 10.1371/journal.pone.0189148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/17/2017] [Indexed: 12/29/2022] Open
Abstract
Background Decision aids can support informed choice in mammography screening, but for the German mammography screening programme no systematically evaluated decision aid exists to date. We developed a decision aid for women invited to this programme for the first time based on the criteria of the International Patient Decision Aids Standards Collaboration. Objective To determine whether a decision aid increases informed choice about mammography screening programme participation. Methods A representative sample of 7,400 women aged 50 was drawn from registration offices in Westphalia-Lippe, Germany. Women were randomised to receive usual care (i.e., the standard information brochure sent with the programme’s invitation letter) or the decision aid. Data were collected online at baseline, post-intervention, and 3 months follow-up. The primary outcome was informed choice. Secondary outcomes were the constituents of informed choice (knowledge, attitude, intention/uptake), decisional conflict, decision regret, and decision stage. Outcomes were analysed using latent structural equation models and χ2-tests. Results 1,206 women participated (response rate of 16.3%). The decision aid increased informed choice. Women in the control group had lower odds to make an informed choice at post-intervention (OR 0.26, 95% CI 0.18-0.37) and at follow-up (OR 0.66, 95% CI 0.46-0.94); informed choices remained constant at 30%. This was also reflected in lower knowledge and more decisional conflict. Post-intervention, the uptake intention was higher in the control group, whereas the uptake rate at follow-up was similar. Women in the control group had a more positive attitude at follow-up than women receiving the decision aid. Decision regret and decision stage were not influenced by the intervention. Conclusion This paper describes the first systematic evaluation of a newly developed decision aid for the German mammography screening programme in a randomised controlled trial. Our decision aid proved to be an effective tool to enhance the rate of informed choice and was made accessible to the public. Trial registration German Clinical Trials Register DRKS00005176.
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Martínez-Alonso M, Carles-Lavila M, Pérez-Lacasta MJ, Pons-Rodríguez A, Garcia M, Rué M. Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis. BMJ Open 2017; 7:e016894. [PMID: 28988175 PMCID: PMC5640065 DOI: 10.1136/bmjopen-2017-016894] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies is to assess the effect of decision aids (DAs) in women aged 50 and below facing the decision to be screened for breast cancer. SETTING Screening for breast cancer. INTERVENTION DAs aimed to help women make a deliberative choice regarding participation in mammography screening by providing information on the options and outcomes. ELIGIBLE STUDIES We included published original, non-pilot, studies that assess the effect of DAs for breast cancer screening. We excluded the studies that evaluated only participation intention or actual uptake. The studies' risk of bias was assessed with the Cochrane Collaboration's tool for RCTs and the National Institutes of Health Quality Assessment Tool for non-RCTs. PRIMARY AND SECONDARY OUTCOMES The main outcome measures were informed choice, decisional conflict and/or confidence, and knowledge. Secondary outcomes were values, attitudes, uncertainty and intention to be screened. RESULTS A total of 607 studies were identified, but only 3 RCTs and 1 before-after study were selected. The use of DAs increased the proportion of women making an informed decision by 14%, 95% CI (2% to 27%) and the proportion of women with adequate knowledge by 12%, 95% CI (7% to 16%). We observed heterogeneity among the studies in confidence in the decision. The meta-analysis of the RCTs showed a significant decrease in confidence in the decision and in intention to be screened. CONCLUSIONS Tools to aid decision making in screening for breast cancer improve knowledge and promote informed decision; however, we found divergent results on decisional conflict and confidence in the decision. Under the current paradigm change, which favours informed choice rather than maximising uptake, more research is necessary for the improvement of DAs.
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Affiliation(s)
- Montserrat Martínez-Alonso
- Department of Basic Medical Sciences, University of Lleida-IRBLLEIDA, Lleida, Spain
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
| | - Misericòrdia Carles-Lavila
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Centre on Industrial and Public Economics (CREIP), Reus, Spain
| | - Maria José Pérez-Lacasta
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
- Department of Economics, University Rovira i Virgili, Reus, Spain
| | | | - Montse Garcia
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Spain
| | - Montserrat Rué
- Department of Basic Medical Sciences, University of Lleida-IRBLLEIDA, Lleida, Spain
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
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Carles M, Martínez-Alonso M, Pons A, Pérez-Lacasta MJ, Perestelo-Pérez L, Sala M, Vidal C, Garcia M, Toledo-Chávarri A, Codern N, Feijoo-Cid M, Romero A, Pla R, Soler-González J, Castells X, Rué M. The effect of information about the benefits and harms of mammography on women's decision-making: study protocol for a randomized controlled trial. Trials 2017; 18:426. [PMID: 28899412 PMCID: PMC5596499 DOI: 10.1186/s13063-017-2161-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The decision to participate or not in breast cancer screening is complex due to the trade-off between the expected benefit of breast cancer mortality reduction and the major harm of overdiagnosis. It seems ethically necessary to inform women so that they can actively participate in decision-making and make an informed choice based on their values and preferences. The objective of this study is to assess the effects of receiving information about the benefits and harms of screening on decision-making, in women approaching the age of invitation to mammography screening. METHODS A two-stage, randomized controlled trial (RCT). In the first stage, 40 Basic Health Areas (BHAs) will be selected and randomized to intervention or control. In the second stage, women within each BHA will be randomly selected (n = 400). Four breast cancer screening programs (BCSPs) of the Spanish public health system, three in Catalonia and one in the Canary Islands will participate in the study. Women in the intervention arm will receive a leaflet with detailed information on the benefits and harms of screening using mammography. Women in the control arm will receive a standard leaflet that does not mention harms and recommends accepting the invitation to participate in the biennial examinations of the BCSP. The primary outcome is informed choice, a dichotomous variable that combines knowledge, attitudes, and intentions. Secondary outcomes include decisional conflict; confidence in the decision made; anxiety about screening participation; worry about breast cancer; anticipated regret; time perspective; perceived importance of benefits/harms of screening; perceived risk of breast cancer; and leaflet acceptability. Primary and secondary outcomes are assessed 2-3 weeks after the intervention. DISCUSSION This is the first RCT that assesses the effect of informing about the benefits and harms of breast cancer screening in Spain in women facing the decision to be screened using mammography. It aims to assess the impact of information on several decisional outcomes and to contribute to paving the road towards shared decision-making in breast cancer screening in our country. TRIAL REGISTRATION ClinicalTrials.gov registry, ID: NCT03046004 . Retrospectively registered on 4 February 2017. Trial name: InforMa study.
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Affiliation(s)
- Misericòrdia Carles
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
- Research Centre on Industrial and Public Economics, (CREIP), Reus, Spain
| | | | - Anna Pons
- Lleida Biomedical Research Institute (IRBLLEIDA), Lleida, Spain
| | - Maria José Pérez-Lacasta
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
- Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Maria Sala
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Spain
| | - Montse Garcia
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Spain
| | - Ana Toledo-Chávarri
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Canary Islands Foundation of Health Research (FUNCANIS), Tenerife, Spain
| | - Núria Codern
- ÀreaQ, Evaluation and Qualitative Research, Barcelona, Spain
- Nursing and Occupational Therapy School (EUIT), Terrassa, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anabel Romero
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Roger Pla
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
- Catalan Health Service, Tarragona Region, Tarragona, Spain
- Medical School, University Rovira i Virgili, Reus, Spain
| | - Jorge Soler-González
- Lleida Biomedical Research Institute (IRBLLEIDA), Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
| | - Xavier Castells
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Montserrat Rué
- Research Group on Economic Evaluation and Health (GRAES), Reus, Spain
- Department of Basic Medical Sciences, University of Lleida-IRBLLEIDA, Lleida, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
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Ivlev I, Hickman EN, McDonagh MS, Eden KB. Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis. J Gen Intern Med 2017; 32:803-812. [PMID: 28289963 PMCID: PMC5481237 DOI: 10.1007/s11606-017-4027-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women's behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women's intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA. METHODS We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended. RESULTS We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04-2.13]; P = 0.03), particularly for younger (38-50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69-89 years) to discontinue screening. CONCLUSIONS The use of BCS-PtDAs increased younger women's reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38-50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography. REGISTRATION The protocol of this review is registered in the PROSPERO database, #CRD42016036695.
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Affiliation(s)
- Ilya Ivlev
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
| | - Erin N Hickman
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Marian S McDonagh
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Karen B Eden
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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DuBenske LL, Schrager S, McDowell H, Wilke LG, Trentham-Dietz A, Burnside ES. Mammography Screening: Gaps in Patient's and Physician's Needs for Shared Decision-Making. Breast J 2017; 23:210-214. [PMID: 28252231 DOI: 10.1111/tbj.12779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As shared decision-making increasingly influences screening mammography, understanding similarities and differences between patients and physician perspectives becomes crucially important. This study compares women's and physicians' experiences of mammography shared decision-making. Results reflect the critical gaps which exist between women's expectations and physicians' confidence in shared decision-making regarding screening mammography.
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Affiliation(s)
- Lori L DuBenske
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sarina Schrager
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Helene McDowell
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lee G Wilke
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
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31
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Toledo-Chávarri A, Rué M, Codern-Bové N, Carles-Lavila M, Perestelo-Pérez L, Pérez-Lacasta MJ, Feijoo-Cid M. A qualitative study on a decision aid for breast cancer screening: Views from women and health professionals. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28145105 DOI: 10.1111/ecc.12660] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/28/2022]
Abstract
This qualitative study evaluates a decision aid that includes the benefits and harms of breast cancer screening and analyses women's perception of the information received and healthcare professionals' perceptions of the convenience of providing it. Seven focus groups of women aged 40-69 years (n = 39) and two groups of healthcare professionals (n = 23) were conducted in Catalonia and the Canary Islands. The focus groups consisted of guided discussions regarding decision-making about breast cancer screening, and acceptability and feasibility of the decision aid. A content analysis was performed. Women positively value receiving information regarding the benefits and harms of breast cancer screening. Several women had difficulties understanding some concepts, especially those regarding overdiagnosis. Women preferred to share the decisions on screening with healthcare professionals. The professionals noted the lack of inclusion of some harms and benefits in the decision aid, and proposed improving the clarity of the statistical information. The information on overdiagnosis generates confusion among women and controversy among professionals. Faced with the new information presented by the decision aid, the majority of women prefer shared decision-making; however, its feasibility might be limited by a lack of knowledge and attitudes of rejection from healthcare professionals.
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Affiliation(s)
- A Toledo-Chávarri
- Canary Islands Foundation of Health Research (FUNCANIS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - M Rué
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Basic Medical Sciences Department, University of Lleida-IRBLLEIDA, Lleida, Spain.,Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain
| | - N Codern-Bové
- ÀreaQ, Evaluation and Qualitative Research, Barcelona, Spain.,Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Terrassa, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M Carles-Lavila
- Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain.,Department of Economics and CREIP, Rovira i Virgili University (URV), Tarragona, Spain
| | - L Perestelo-Pérez
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - M J Pérez-Lacasta
- Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain.,Department of Economics and CREIP, Rovira i Virgili University (URV), Tarragona, Spain
| | - M Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, Bellaterra, Spain.,Researcher in Grups de Recerca d'America i Àfrica Llatines (GRAAL) (2014 SGR 1175), Barcelona, Spain.,Researcher Collaborator of the Infectious Diseases Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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32
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Saver BG, Mazor KM, Luckmann R, Cutrona SL, Hayes M, Gorodetsky T, Esparza N, Bacigalupe G. Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions. Ann Fam Med 2017; 15:48-55. [PMID: 28376460 PMCID: PMC5217843 DOI: 10.1370/afm.1996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/19/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODS We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict. RESULTS Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = <.001) for men and -0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure. CONCLUSIONS Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.
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Affiliation(s)
- Barry G Saver
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
- Swedish Family Medicine Residency Cherry Hill, Seattle, Washington
| | - Kathleen M Mazor
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
| | - Roger Luckmann
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
- Veterans Health Administration, HSRD COIN Edith Nourse Rogers Memorial Hospitalo, Bedford, Massachusetts
| | - Marcela Hayes
- University of Massachusetts Medical School, Worcester, Massachusetts
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33
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Klein KA, Watson L, Ash JS, Eden KB. Evaluation of risk communication in a mammography patient decision aid. PATIENT EDUCATION AND COUNSELING 2016; 99:1240-1248. [PMID: 26965020 PMCID: PMC5022358 DOI: 10.1016/j.pec.2016.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 05/22/2023]
Abstract
OBJECTIVES We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. METHODS Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women. RESULTS Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. CONCLUSIONS Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. PRACTICE IMPLICATIONS Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics.
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Affiliation(s)
- Krystal A Klein
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | - Lindsey Watson
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | - Joan S Ash
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | - Karen B Eden
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
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Klein KA, Watson L, Ash JS, Eden KB. Evaluation of risk communication in a mammography patient decision aid. PATIENT EDUCATION AND COUNSELING 2016; 99:1240-1248. [PMID: 26965020 DOI: 10.1016/j.pec.20160.020.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 05/22/2023]
Abstract
OBJECTIVES We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. METHODS Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women. RESULTS Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. CONCLUSIONS Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. PRACTICE IMPLICATIONS Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics.
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Affiliation(s)
- Krystal A Klein
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | - Lindsey Watson
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | - Joan S Ash
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
| | - Karen B Eden
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA.
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