Use of patient decision aids increased younger women’s reluctance to begin screening mammography: a systematic review and meta-analysis
- 512 Downloads
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.
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.
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.
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.
The protocol of this review is registered in the PROSPERO database, #CRD42016036695.
KEY WORDSbreast cancer screening mammography decision support techniques patient decision aid intention utilization of screening mammography
breast cancer screening patient decision aid
Cochrane Central Register of Controlled Trials
International Patient Decision Aid Standards
patient decision aid
randomized controlled trial
- 1.Stewart BW, Wild CP. Breast cancer. In: World Cancer Report 2014. Lyon: International Agency for Research on Cancer; 2014:362–373.Google Scholar
- 2.American Cancer Society. Breast Cancer. How Common Is Breast Cancer? http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Published 2016. Accessed 16 Feb 2017.
- 3.World Health Organization. WHO Position Paper on Mammography Screening. Geneva: World Health Organization; 2014:27–32.Google Scholar
- 12.Australian Government Department of Health. About breast screening. BreastScreen Australia Program. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/about-breast-screening. Published March 2015. Accessed 16 Feb 2017.
- 14.Canadian Cancer Society. Screening for breast cancer. Screening mammography. http://www.cancer.ca/en/cancer-information/cancer-type/breast/screening/?region=on. Accessed 16 Feb 2017.
- 21.Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. In: Stacey D, ed. Cochrane Database of Systematic Reviews. Vol 1. Chichester, UK: John Wiley & Sons, Ltd; 2014:CD001431. doi:10.1002/14651858.CD001431.pub4.
- 22.Ivlev I, Hickman EN, McDonagh MS, Eden KB. Women’s change in intention to undergo screening mammography after using a patient decision aid: a systematic review and meta-analysis. 2016. Available at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016036695. Accessed 16 Feb 2017.
- 25.National Institutes of Health. Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Study Quality Assessment Tools. https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/before-after. Published April 2014. Accessed 16 Feb 2017.
- 26.The Cochrane Collaboration. Chapter 8: Assessing risk of bias in included studies. In: Higgins J, Altman D, Sterne J, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]. The Cochrane Collaboration; 2011. Available at: www.cochranehandbook.org. Accessed 16 Feb 2017.Google Scholar
- 27.Harris RJ, Bradburn MJ, Deeks JJ, Altman DG, Harbord RM, Sterne JAC. Metan: fixed- and random-effects meta-analysis. Stata J. 2008;8(1):3–28.Google Scholar
- 30.Review Manager (RevMan) [Computer program]. Version 5.3.5. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.Google Scholar
- 31.The Cochrane Collaboration. Computing absolute risk reduction or NNT from a risk ratio (RR). In: Higgins J, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]; 2011. Available at: www.cochranehandbook.org. Accessed 1 June 2016.
- 32.Lewis CL, Pignone MP, Sheridan SL, Downs SM, Kinsinger LS. A randomized trial of three videos that differ in the framing of information about mammography in women 40 to 49 years old. J Gen Intern Med. 2003;18(11):875–883. doi:10.1046/j.1525-1497.2003.21152.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Hersch J, Barratt A, Jansen J, et al. The effect of information about overdetection of breast cancer on women’s decision-making about mammography screening: study protocol for a randomised controlled trial. BMJ Open. 2014;4(5), e004990. doi:10.1136/bmjopen-2014-004990.CrossRefPubMedPubMedCentralGoogle Scholar