Abstract
BackgroundIn 2009 the United States Preventive Services Task Force updated its breast cancer screening guidelines to recommend that average-risk women obtain a screening mammogram every two years starting at age 50 instead of annually starting at age 40. Inconsistencies in data regarding the benefit versus risk of routine screening for women less than 50-years-of-age led to a second recommendation – that women in their forties engage in a shared decision making process with their provider to make an individualized choice about screening mammography that was right for them. In response, a web-based interactive mammography screening decision aid was developed and evaluated.MethodsThe decision aid was developed using an agile, iterative process. It was further honed based on feedback from clinical and technical subject matter experts. A convenience sample of 51 age- and risk-appropriate women was recruited to pilot the aid. Pre-post decisional conflict and screening choice was assessed.ResultsWomen reported a significant reduction in overall decisional conflict after using the decision aid (Z = -5.3, p < 0.001). These participants also reported statistically significant reductions in each of the decisional conflict subscales: feeling uncertain (Z = -4.7, p < 0.001), feeling uninformed (Z = -5.2, p < 0.001), feeling unclear about values (Z = -5.0, p < 0.001), and feeling unsupported (Z = -4.0, p < 0.001). However, a woman’s intention to obtain a screening mammogram in the next 1-2 years was not significantly changed (Wilcoxon signed-rank Z = -1.508, p = 0.132).ConclusionThis mammography screening decision aid brings value to patient care not by impacting what a woman chooses but by lending clarity to why or how she chooses it.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-015-0210-2) contains supplementary material, which is available to authorized users.
Highlights
In 2009 the United States Preventive Services Task Force updated its breast cancer screening guidelines to recommend that average-risk women obtain a screening mammogram every two years starting at age 50 instead of annually starting at age 40
The guidelines transitioned from recommending that average-risk women obtain a screening mammogram yearly starting at age 40 to undergoing screening every two years starting at age 50 [7, 8]
Decision aid description The decision aid was organized into six sections and the content was guided by International Patient Decision Aid Standards (IPDAS) collaboration criteria [16]: (1) welcome, (2) breast cancer risk factors, (3) mammography information, (4) values clarification, (5) summary and (6) final questions
Summary
In 2009 the United States Preventive Services Task Force updated its breast cancer screening guidelines to recommend that average-risk women obtain a screening mammogram every two years starting at age 50 instead of annually starting at age 40. Inconsistencies in data regarding the benefit versus risk of routine screening for women less than 50-years-of-age led to a second recommendation – that women in their forties engage in a shared decision making process with their provider to make an individualized choice about screening mammography that was right for them. The guidelines transitioned from recommending that average-risk women obtain a screening mammogram yearly starting at age 40 to undergoing screening every two years starting at age 50 [7, 8]. Shared decision making is ideal when the tradeoff between benefits and harms is either unclear or unknown.
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