TAILORING, EXEMPLARS, AND AMOUNT OF INFORMATION IN AN ONLINE MAMMOGRAPHY DECISION AID: EFFECTS ON DECISION PROCESS OUTCOMES

Purpose: This experiment examined how components of a personalized online mammography decision aid (DA; components included exemplars, tailoring, and amount of information) for younger women affect decision process outcomes, including knowledge, decisional conflict, and emotions.

Method: A web-based sample of 2,918 women ages 35 – 49 were stratified into two levels of 10-year breast cancer risk (<1.5%; ≥1.5%) and then randomly assigned to one of eight different conditions (within level of risk).  Conditions included two control conditions and DA conditions varying on inclusion of exemplars (exemplars vs. expository), tailoring (exemplars tailored to participant's breast cancer risk, age, race, family history, and maternal status vs. untailored exemplars), and amount of information (brief vs. extended). All DA conditions included personalized 10-year and lifetime breast cancer risk (calculated using the Gail model; Gail & Costantino, 2001) and arguments for and against having mammograms between the ages of 40 and 49 years old (balance of arguments varied across risk levels).

Result: Compared to control conditions, DA conditions produced increases in knowledge of the age group for which mammograms are most effective and knowledge that mammograms do not detect every breast cancer.  This effect was especially pronounced for the extended DA conditions.  There were no significant differences in decisional conflict across experimental conditions.  For women at both levels of risk, some of the DA conditions led to small but significant increases in worry (see table).  This effect was most pronounced for women with a 10-year risk ≥ 1.5%.  For women with a 10-year risk ≥ 1.5%, some of the DA conditions also led to a small but significant increase in fear.  For women with a 10-year risk ≥ 1.5%, there appears to be a trend toward smaller increases in worry and fear in the tailored exemplar conditions (moderation effect is marginally significant for fear, not significant for worry).    

Conclusion: These findings suggest that DAs with more information can lead to increased knowledge gains without negative consequences on decisional conflict.  The emotion findings suggest that, though some versions of the DA increased reported worry and fear, the use of tailored exemplars may have had a buffering effect on these negative emotions and could be useful in minimizing negative affect generated by DAs.