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Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid.

Abstract

OBJECTIVE

To develop, pilot and refine a decision aid (ahead of a randomised trial evaluation) for women around age 50 facing their initial decision about whether to undergo mammography screening.

DESIGN

Two-stage mixed-method pilot study including qualitative interviews (n=15) and a randomised comparison using a quantitative survey (n=34).

SETTING

New South Wales, Australia.

PARTICIPANTS

Women aged 43-59 years with no personal history of breast cancer.

INTERVENTIONS

The decision aid provides evidence-based information about important outcomes of mammography screening over 20 years (breast cancer mortality reduction, overdetection and false positives) compared with no screening. The information is presented in a short booklet for women, combining text and visual formats. A control version produced for the purposes of comparison omits the overdetection-related content.

OUTCOMES

Comprehension of key decision aid content and acceptability of the materials.

RESULTS

Most women considered the decision aid clear and helpful and would recommend it to others. Nonetheless, the piloting process raised important issues that we tried to address in iterative revisions. Some participants found it hard to understand overdetection and why it is of concern, while there was often confusion about the distinction between overdetection and false positives. In a screening context, encountering balanced information rather than persuasion appears to be contrary to people's expectations, but women appreciated the opportunity to become better informed.

CONCLUSIONS

The concept of overdetection is complex and new to the public. This study highlights some key challenges for communicating about this issue. It is important to clarify that overdetection differs from false positives in terms of its more serious consequences (overtreatment and associated harms). Screening decision aids also must clearly explain their purpose of facilitating informed choice. A staged approach to development and piloting of decision aids is recommended to further improve understanding of overdetection and support informed decision-making about screening.

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  • Authors+Show Affiliations

    ,

    Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    ,

    Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    ,

    Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    ,

    Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    ,

    Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    ,

    School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    ,

    Department of Health Sciences, University of Leicester, Leicester, UK.

    ,

    Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.

    Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

    Source

    BMJ open 4:9 2014 Sep 25 pg e006016

    MeSH

    Adult
    Breast Neoplasms
    Decision Support Techniques
    Early Detection of Cancer
    False Positive Reactions
    Female
    Humans
    Interviews as Topic
    Mammography
    Middle Aged
    Pilot Projects
    Qualitative Research

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25256188

    Citation

    Hersch, Jolyn, et al. "Overdetection in Breast Cancer Screening: Development and Preliminary Evaluation of a Decision Aid." BMJ Open, vol. 4, no. 9, 2014, pp. e006016.
    Hersch J, Jansen J, Barratt A, et al. Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid. BMJ Open. 2014;4(9):e006016.
    Hersch, J., Jansen, J., Barratt, A., Irwig, L., Houssami, N., Jacklyn, G., ... McCaffery, K. (2014). Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid. BMJ Open, 4(9), pp. e006016. doi:10.1136/bmjopen-2014-006016.
    Hersch J, et al. Overdetection in Breast Cancer Screening: Development and Preliminary Evaluation of a Decision Aid. BMJ Open. 2014 Sep 25;4(9):e006016. PubMed PMID: 25256188.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid. AU - Hersch,Jolyn, AU - Jansen,Jesse, AU - Barratt,Alexandra, AU - Irwig,Les, AU - Houssami,Nehmat, AU - Jacklyn,Gemma, AU - Thornton,Hazel, AU - Dhillon,Haryana, AU - McCaffery,Kirsten, Y1 - 2014/09/25/ PY - 2014/9/27/entrez PY - 2014/9/27/pubmed PY - 2015/6/24/medline KW - PREVENTIVE MEDICINE KW - PUBLIC HEALTH KW - QUALITATIVE RESEARCH SP - e006016 EP - e006016 JF - BMJ open JO - BMJ Open VL - 4 IS - 9 N2 - OBJECTIVE: To develop, pilot and refine a decision aid (ahead of a randomised trial evaluation) for women around age 50 facing their initial decision about whether to undergo mammography screening. DESIGN: Two-stage mixed-method pilot study including qualitative interviews (n=15) and a randomised comparison using a quantitative survey (n=34). SETTING: New South Wales, Australia. PARTICIPANTS: Women aged 43-59 years with no personal history of breast cancer. INTERVENTIONS: The decision aid provides evidence-based information about important outcomes of mammography screening over 20 years (breast cancer mortality reduction, overdetection and false positives) compared with no screening. The information is presented in a short booklet for women, combining text and visual formats. A control version produced for the purposes of comparison omits the overdetection-related content. OUTCOMES: Comprehension of key decision aid content and acceptability of the materials. RESULTS: Most women considered the decision aid clear and helpful and would recommend it to others. Nonetheless, the piloting process raised important issues that we tried to address in iterative revisions. Some participants found it hard to understand overdetection and why it is of concern, while there was often confusion about the distinction between overdetection and false positives. In a screening context, encountering balanced information rather than persuasion appears to be contrary to people's expectations, but women appreciated the opportunity to become better informed. CONCLUSIONS: The concept of overdetection is complex and new to the public. This study highlights some key challenges for communicating about this issue. It is important to clarify that overdetection differs from false positives in terms of its more serious consequences (overtreatment and associated harms). Screening decision aids also must clearly explain their purpose of facilitating informed choice. A staged approach to development and piloting of decision aids is recommended to further improve understanding of overdetection and support informed decision-making about screening. SN - 2044-6055 UR - https://wwww.unboundmedicine.com/medline/citation/25256188/Overdetection_in_breast_cancer_screening:_development_and_preliminary_evaluation_of_a_decision_aid_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=25256188 DB - PRIME DP - Unbound Medicine ER -