Method: An expert panel reviewed iterative versions of the DA and it was then reviewed for acceptability by 15 patients and 5 of their primary care physicians (PCP). The 11-page DA (written at a 6th grade reading level) includes information on breast cancer risk, life expectancy, competing mortality risks, outcomes of screening, and a values clarification exercise. We evaluated this DA in a before/after trial at a large academic practice. Eligible women were >75 years, spoke and read English fluently, had not had a mammogram in 9 months but were screened in the past 3 years, did not have a history of breast cancer or dementia, and were scheduled for a routine visit with their PCP within 8 weeks. Before a PCP visit, participants completed a “before” survey and read the DA. After the visit, participants completed an “after” survey. Surveys included 10 knowledge questions, the decisional conflict scale (DCS, 0-100, lower scores= less conflict), and a question assessing intentions to be screened. We used the signed rank test and McNemar’s test to compare before/after responses. Participants were also followed by medical record to examine 1) whether there was a note documenting a discussion of risks/benefits of mammography within 9 months and 2) receipt of mammography within 15 months.
Result: Forty-nine participants had a median age of 79 years; 71% were Non-Hispanic white; and 63% had attended some college. Comparison of “after” to “before” survey results found: 1) participants answered on average 1 more question correct (interquartile range 0-2) from 6 to 7 questions correct, p<0.001; 2) decisional conflict declined by 4.7 points (range -10.2 to +4.7 points, mean DCS scores before=20.2, p=0.03); and 3) fewer participants intended to be screened (59% compared to 82% before, p=0.01). In the following 9 months, 58% of participants had a PCP note documenting a discussion of mammography. While 84% had been screened within 2 years before participating, 58% were screened within 2 years since their last mammogram after participating. Overall, 94% reported that they would recommend the DA and 94% found it helpful.
Conclusion: We developed a DA for women >75 years that improves their decision-making around mammography screening.
See more of: The 35th Annual Meeting of the Society for Medical Decision Making