Decision Aid Including Information on Overdetection Increases Informed Choice in Breast Screening and Reduces Intention to Be Screened
In a study reported in The Lancet, Hersch et al found that use of a decision aid containing information on overdetection in breast cancer screening was associated with an increased rate of informed choice regarding screening, a reduced rate of positive attitudes toward screening, and reduced intention to be screened.
Study Details
In the community-based trial conducted in New South Wales, Australia, 879 women aged 48 to 50 years who had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer were randomly assigned between January 2014 and July 2014 to receive an intervention decision aid including evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false-positives (n = 440) or a control decision aid including information on breast cancer mortality reduction and false-positives (n = 439). The primary outcome was informed choice, defined as adequate knowledge and consistency between attitudes and screening intentions. Participants were interviewed via telephone at 3 weeks after randomization. The primary outcome was analyzed in all women who completed all follow-up interview questions.
Informed Choice and Attitudes
Among the two cohorts, 21 women in the intervention group and 20 in the control group were lost to follow-up, and 10 and 11 did not answer all interview questions. Among 409 women in the intervention group and 408 in the control group, 99 vs 63 (24% vs 15%, difference = 9%, P = .0017) were considered to have made an informed choice regarding screening. Compared with the control group, significantly more women in the intervention group met the threshold for adequate overall knowledge (29% vs 17%, difference = 12%, P < .0001), significantly fewer expressed positive attitudes toward screening (69% vs 83%, difference = 14%, P < .0001), and significantly fewer intended to be screened (74% vs 87%, difference = 13%, P < .0001).
When informed choice status was determined based on conceptual knowledge alone, the rate of informed choice was 50% in the intervention group vs 19% in the control group (P < .0001).
The investigators concluded: “Information on overdetection of breast cancer provided within a decision aid increased the number of women making an informed choice about breast screening. Becoming better informed might mean women are less likely to choose screening.”
Kirsten McCaffery, PhD, of the University of Sydney, is the corresponding author of The Lancet article.
The study was funded by the Australian National Health and Medical Research Council. The study authors reported no potential conflicts of interest.
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