PS2-30 EFFECT OF PATIENT DECISION AIDS ON WOMEN'S INTENTION TO UNDERGO SCREENING MAMMOGRAPHY: SYSTEMATIC REVIEW AND META-ANALYSIS

Purpose:  The World Health Organization, U.S. Preventive Services Task Force (USPSTF), and American Cancer Society (ACS) state that decisions regarding breast cancer screening should be tailored to the values of a patient. The purpose of this systematic review was to answer the following questions: (1) how do patient decision aids (PtDAs) change women's intention to undergo screening mammography; (2) do women from different age groups (38-49, and older than 69) have a similar screening intention after use of a breast cancer screening PtDA?

Method:  A search for evidence was performed using the following databases: MEDLINE (Ovid), PsycINFO, Health and Psychosocial Instruments, CENTRAL, Cochrane Methodology Register, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and PsycARTICLES. All potentially eligible articles were reviewed individually by two researchers for inclusion/exclusion, extraction of data, and risk of bias assessment.  When disagreement occurred, a third author was consulted, and the topic was discussed until consensus was reached. The proportions of women that intended to be screened, not intended to be screened, or were unsure about undergoing breast cancer screening were pooled using random effects model meta-analysis techniques according to published standards.  

Result:  We found 58 potentially eligible papers; three RCTs and three before-after studies met inclusion criteria and provided screening intention data for 2,040 women. In trials, compared to usual care, PtDAs resulted in significantly more women not intending to undergo screening mammography, relative risk (RR) 1.48 (95% CI 1.04 to 2.13, n=3).  Also, more women age 38-49 years old with average breast cancer risk did not intend to be screened after using a PtDA (RR 1.48; 95% CI 1.02 to 2.14, n=4). In the two studies of women age 69-89 years, PtDAs did not affect intention to continue breast cancer screening.

Conclusion:  Use of a patient decision aid reduced younger women's intention to be screened for breast cancer before age 50.  The topic of using PtDAs to help women make informed decisions about mammography screening is relatively new (included studies were published between 2007-2015) and more work is needed to fully understand the behavior change in screening after using an evidence-based decision aid.