DECISION SUPPORT FOR SCREENING MAMMOGRAPHY: EVALUATION OF A WEB-BASED DECISION AID FOR WOMEN IN THEIR 40'S

Purpose: Current guidelines recommend against routine screening mammography for women in their 40’s at low to average risk of breast cancer (BC), instead advocating individualized decisions based on expected benefits and harms of screening and personal preference. We developed a self-administered, web-based decision aid (DA) to help women decide when to start (age 40 vs. 50) and how often to have (annually or biennially) screening mammograms.

Method: The evidence-based DA, Breast Screening Decisions (BSD), was modeled on the Ottawa Decision Support framework and adheres with established criteria for DA development and evaluation. BSD provides predicted risk of BC based on the Gail model, information about benefits and harms of screening conveyed in text and pictograms, and a values-clarification exercise. In an ongoing pilot study, women age 40-49 with a scheduled preventive care visit at a large, university-affiliated women’s health practice were invited by mail and email to use the BSD prior to their visit. We excluded women at high risk of BC due to specific characteristics or predicted risk. Users completed a usability and acceptability survey prior to exiting the DA.

Result: To date, 46 women of 262 invited have accessed BSD, of whom 33 provided consent and 20 met criteria for low to average BC risk.  Median predicted 5-year BC risk in the 20 eligible women was 1.05% and median lifetime risk was 12.9%. Of 11 women who completed the survey, all stated that BSD contained important information, was easy to navigate, and presented information clearly. Nine of 11 women said that graphs and illustrations helped them understand concepts, and nine would recommend the website to other women.

Conclusion: Preliminary results suggest that BSD is a feasible, acceptable way of facilitating informed decision making about screening mammography for women in their 40’s. Information from follow-up surveys with users and their physicians will describe the impact of BSD on knowledge and anxiety about screening mammography, actual or intended use of screening, decision satisfaction and decisional conflict, and physician perceptions of women’s knowledge and anxiety about screening. If BSD is acceptable to patients and providers and has a favorable impact on the decision-making process, it can support informed, individualized, and shared decisions about screening mammography for millions of women in the US each year.