DEVELOPMENT AND EVALUATION OF A DECISION AID ON MAMMOGRAPHY SCREENING FOR WOMEN AGED 75 AND OLDER

Sunday, October 20, 2013
Key Ballroom Foyer (Hilton Baltimore)
Poster Board # P1-20
Decision Psychology and Shared Decision Making (DEC)

Mara A. Schonberg, MD, MPH1, Mary Beth Hamel, MD, MPH1, Roger B. Davis, ScD1, Angela Fagerlin, PhD2 and Edward R. Marcantonio3, (1)Beth Israel Deaconess Medical Center, Brookline, MA, (2)VA Ann Arbor Healthcare System & University of Michigan, Ann Arbor, MI, (3)Division of General Medicine and Primary Care, Brookline, MA
Purpose:  To design and evaluate a decision aid (DA) for women >75 years to inform their decision-making around mammography screening.

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.