Abstract B77: Shared decision-making and mammography screening: A national sample

Abstract

Abstract Current breast cancer screening guidelines promote the use of shared decision-making (SDM) between patients and providers. Given the mandate of the Affordable Care Act to use SDM in clinical practice, it is imperative to develop an understanding of its impact on quality of care in the United States (US), especially for minority populations with poor cancer outcomes. The aim of this study is to examine the impact of two key elements of shared decision making on the use of mammogram screening: Patient-reported choice and patient-provider communication. Data was obtained from the National Cancer Institute's Health Information National Trends Survey (HINTS) 4, a nationally representative survey of the US population administered via mail in 2011-2013. Generalized logit models assessed the impact of patient choice and communication on the utilization of mammography using weighted sample data. Women who answered yes to the question “Has a doctor ever told you that you could choose whether or not to have a mammogram?” were considered to have participated in SDM with their provider. Patient-provider communication was measured using a scale of 7 survey items that demonstrated excellent internal consistency (Cronbach alpha= 0.92) where higher scores correspond to better communication. The main outcome variable was patient-reported utilization of mammogram screening: having a mammogram within the past two years, more than two years ago, or never. Final models controlled for socioeconomic variables, health insurance, and whether women had a family or personal history of cancer. The final unweighted sample included 2,303 women: 73% non-Hispanic white, 11% Hispanic, 10% black, and 6% ‘other’. More than half were married (54%) and most rated their health as good or better (84%). The mean age of respondents was 45.5 years. Thirty six percent of women had obtained a college degree and 89% had some form of health insurance. About half (50.9% ) had a mammogram within the past two years, 11% had one more than two years ago, and 38% reported never having a mammogram. Thirty five percent reported being given a choice to undergo mammogram screening. Women reported high levels of communication with providers with a mean communication score of 23.1 (range 7-28). No racial differences were found related to choice or communication. In multivariate analyses, those who reported being told they had a choice to have a mammogram were more likely to have had a mammogram within the past two years (OR=2.42, 95% CI: 1.35-4.37) or more than two years ago (OR=3.76, 95% CI: 2.07, 6.81) relative to those who did not have a choice. Patient-provider communication had no significant association with having a mammogram within the past two years, but those with a higher communication score were less likely to have mammogram more than two years ago compared to those with lower scores (OR=0.93, 95% CI: 0.88, 0.99). Hispanic and black women had a significantly increased odds of having a mammogram recently (OR(Hisp)= 2.90, 95% CI: 1.41, 5.98; OR(black)= 2.52, 95% CI: 1.00, 6.35), with Hispanic women also having an increased odds of having one more than two years ago (OR= 2.87, 95% CI: 1.17, 6.99) compared to non-Hispanic white women. No racial differences were found in patient-reported measures of shared decision-making. The perception of having a choice to undergo mammogram screening is positively associated with the use of mammography services. This finding was independent of patient race/ethnicity. Citation Format: Christine M. Gunn, Marina Soley-Bori, Tracy A. Battaglia. Shared decision-making and mammography screening: A national sample. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B77. doi:10.1158/1538-7755.DISP13-B77