Abstract
OBJECTIVE: To assess the effect of providing structured information about the benefits and harms of mammography in differing frames on women’s perceptions of screening.
DESIGN: Randomized control trial.
SETTING: General internal medicine academic practice.
PARTICIPANTS: One hundred seventy-nine women aged 35 through 49.
INTERVENTION: Women received 1 of 3 5-minute videos about the benefits and harms of screening mammography in women aged 40 to 49. These videos differed only in the way the probabilities of potential outcomes were framed (positive, neutral, or negative).
MEASUREMENTS AND MAIN RESULTS: We measured the change in accurate responses to questions about potential benefits and harms of mammography, and the change in the proportion of participants who perceived that the benefits of mammography were more important than the harms. Before seeing the videos, women’s knowledge about the benefits and harms of mammography was inaccurate (82% responded incorrectly to all 3 knowledge questions). After seeing the videos, the proportion that answered correctly increased by 52%, 43%, and 30% for the 3 knowledge questions, respectively, but there were no differences between video frames. At baseline, most women thought the benefits of mammography outweighed the harms (79% positive frame, 80% neutral frame, and 85% negative frame). After the videos, these proportions were similar among the 3 groups (84%, 81%, 83%, P=.93).
CONCLUSIONS: Women improved the accuracy of their responses to questions about the benefits and harms of mammography after seeing the videos, but this change was not affected by the framing of information. Women strongly perceived that the benefits of mammography outweighed the harms, and providing accurate information had no effect on these perceptions, regardless of how it was framed.
Similar content being viewed by others
References
Wells J, Marshall P, Crawley B, Dickersin K. Newspaper reporting of screening mammography. Ann Intern Med. 2001;135:1029–37.
Ernster VL. Mammography screening for women aged 40 through 49—a guidelines saga and a clarion call for informed decision making. Am J Public Health. 1997;87:1103–6.
Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:347–60.
Ransohoff DF, Harris RP. Lessons from the mammography screening controversy: can we improve the debate? Ann Intern Med. 1997;127:1029–34.
Pauker SG, Kassirer JP. Contentious screening decisions: does the choice matter? N Engl J Med. 1997;336:1243–4.
Kerlikowske K. Efficacy of screening mammography among women aged 40–49 years and 50–69 years: comparison of relative and absolute benefit. J Natl Cancer Inst Monogr. 1997;22:79–86.
Napoli M. What do women want to know? J Natl Cancer Inst Monogr. 1997;22:11–3.
Fletcher SW. Breast cancer screening among women in their forties: an overview of the issues. J Natl Cancer Inst Monogr. 1997;22:5–9.
Harris R, Leininger L. Clinical strategies for breast cancer screening: weighing and using the evidence. Ann Intern Med. 1995;122:539–47.
Rimer BK. Putting the ‘informed’ in informed consent about mammography. J Natl Cancer Inst. 1995;87:703–4.
Schwartz LM, Woloshin S, Welch HG. Risk communication in clinical practice: putting cancer in context. J Natl Cancer Inst Monogr. 1999;25:124–33.
Lawrence VA, Streiner D, Hazuda HP, Naylor R, Levine M, Gafni A. A cross-cultural consumer-based decision aid for screening mammography. Prev Med. 2000;30:200–8.
Black WC, Nease RF, Tosteson ANA. Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst. 1995;87:720–31.
Lerman C, Lustbader E, Rimer B, et al. Effects of individualized breast cancer risk counseling: a randomized trial. J Natl Cancer Inst. 1995;87:286–92.
Silverman E, Woloshin S, Schwartz LM, Byram SJ, Welch HG, Fischhoff B. Women’s views on breast cancer risk and screening mammography: a qualitative interview study. Med Decis Making. 2001;21:231–40.
Rubin R. The breast cancer scare. US News & World Report. 1993;68–72.
Slaytor EK, Ward JE. How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets. BMJ. 1998;317:263–4.
Burke W, Olsen AH, Pinsky LE, Reynolds SE, Press NA. Misleading presentation of breast cancer in popular magazines. Eff Clin Pract. 2001;4:58–64.
Schwartz LM, Woloshin S, Black WC, Welch HG. The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med. 1997;127:966–72.
Rimer BK, Halabi S, Sugg Skinner C, et al. The short-term impact of tailored mammography decision-making interventions. Patient Educ Couns. 2001;43:269–85.
Edwards A, Elwyn G, Covey J, Matthews E, Pill R. Presenting risk information—a review of the effects of ‘framing’ and other manipulations on patient outcomes. J Health Commun. 2001;6:61–82.
Levin IP, Schneider SL, Gaeth GJ. All frames are not created equal: a typology and critical analysis of framing effects. Organ Behav Hum Decis Process. 1998;76:149–88.
McNeil BJ, Pauker SG, Sox HC Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982;306:1259–62.
O’Connor AM, Pennie RA, Dales RE. Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. J Clin Epidemiol. 1996;49:1271–6.
Jacoby A, Baker G, Chadwick D, Johnson A. The impact of counselling with a practical statistical model on patients’ decision-making about treatment for epilepsy: findings from a pilot study. Epilepsy Res. 1993;16:207–14.
Llewellyn-Thomas HA, McGreal MJ, Thiel EC. Cancer patients’ decision making and trial-entry preferences: the effects of ‘framing’ information about short-term toxicity and long-term survival. Med Decis Making. 1995;15:4–12.
Friedman LC, Neff NE, Webb JA, Latham CK. Age-related differences in mammography use and in breast cancer knowledge, attitudes, and behaviors. J Cancer Educ. 1998;13:26–30.
Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med. 1998;338:1089–96.
Lerman C, Trock B, Rimer B, Jepson C, Brody D, Boyce A. Psychological side effects of breast cancer screening. Health Psychol. 1991;10:259–67.
NIH, Consensus Statement. Breast cancer screening for women ages 40–49, 1997.
Grimes DA, Snively GR. Patients’ understanding of medical risks: implications for genetic counseling. Obstet Gynecol. 1999;93:910–4.
Costantino JP, Gail MP, Pee D, et al. Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst. 1999;91:1541–8.
Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879–86.
Rockhill B, Spiegelman D, Byrne C, Hunter DJ, Colditz GA. Validation of the Gail et al. model for breast cancer risk prediction and implications for chemoprevention. J Natl Cancer Inst. 2001;93:358–66.
Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.
Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1.
Weinstein ND. What does it mean to understand a risk? Evaluating risk comprehension. J Natl Cancer Inst Monogr. 1999;25:15–20.
Johnson BB, Slovic P. Presenting uncertainty in health risk assessment: initial studies of its effects on risk perception and trust. Risk Anal. 1995;15:485–94.
Alexander NE, Ross J, Sumner W, Nease RF Jr., Littenberg B. The effect of an educational intervention on the perceived risk of breast cancer. J Gen Intern Med. 1996;11:92–7.
Weinstein ND. Testing four competing theories of health-protective behavior. Health Psychol. 1993;12:324–33.
Rakowski W, Dube CE, Marcus BH, Prochaska JO, Velicer WF, Abrams DB. Assessing elements of women’s decisions about mammography. Health Psychol. 1992;11:111–8.
Bogardus ST Jr, Holmboe E, Jekel JF. Perils, pitfalls, and possibilities in talking about medical risk. JAMA. 1999;281:1037–41.
Plous S. The Psychology of Judgement and Decision Making. New York: McGraw-HIll; 1993:22–3.
National Center for Health Statistics. Health, United States. 2002. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hus/listables.pdf #82. Accessed 26 March 2003.
Bastian L, Lipkus I, Kuchibhatla M, et al. Women’s interest in chemoprevention for breast cancer. Arch Intern Med. 2000;161:1639–44.
Schwartz LM, Woloshin S, Sox HC, Fischhoff B, Welch HG. US women’s attitudes to false-positive mammography results and detection of ductal carcinoma in situ: cross-sectional survey. West J Med. 2000;173:307–12.
Nekhlyudov L, Ross-Degnan D, Fletcher SW. Beliefs and expectations of women under 50 years old regarding screening mammography. J Gen Intern Med. 2003;18:182–9.
Author information
Authors and Affiliations
Corresponding author
Additional information
Grant support: This study was supported by the University of North Carolina Lineberger Comprehensive Cancer Center. Drs. Lewis (grant number #00-180-01) and Pignone are supported by the American Cancer Society Cancer Control Career Development Award for Primary Care Physicians. Dr. Sheridan was supported by National Research Services Award PHS#14001-14.
Rights and permissions
About this article
Cite this article
Lewis, C.L., Pignone, M.P., Sheridan, S.L. et al. 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 18, 875–883 (2003). https://doi.org/10.1046/j.1525-1497.2003.21152.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2003.21152.x