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Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis.

Abstract

BACKGROUND

As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women's behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women's intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA.

METHODS

We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended.

RESULTS

We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04-2.13]; P = 0.03), particularly for younger (38-50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69-89 years) to discontinue screening.

CONCLUSIONS

The use of BCS-PtDAs increased younger women's reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38-50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography.

REGISTRATION

The protocol of this review is registered in the PROSPERO database, #CRD42016036695.

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  • Authors+Show Affiliations

    ,

    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. ivlev@ohsu.edu.

    ,

    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.

    ,

    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.

    Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.

    Source

    Journal of general internal medicine 32:7 2017 Jul pg 803-812

    MeSH

    Breast Neoplasms
    Decision Making
    Decision Support Techniques
    Early Detection of Cancer
    Female
    Humans
    Mammography
    Patient Participation
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    28289963

    Citation

    Ivlev, Ilya, et al. "Use of Patient Decision Aids Increased Younger Women's Reluctance to Begin Screening Mammography: a Systematic Review and Meta-analysis." Journal of General Internal Medicine, vol. 32, no. 7, 2017, pp. 803-812.
    Ivlev I, Hickman EN, McDonagh MS, et al. Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis. J Gen Intern Med. 2017;32(7):803-812.
    Ivlev, I., Hickman, E. N., McDonagh, M. S., & Eden, K. B. (2017). Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis. Journal of General Internal Medicine, 32(7), pp. 803-812. doi:10.1007/s11606-017-4027-9.
    Ivlev I, et al. Use of Patient Decision Aids Increased Younger Women's Reluctance to Begin Screening Mammography: a Systematic Review and Meta-analysis. J Gen Intern Med. 2017;32(7):803-812. PubMed PMID: 28289963.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis. AU - Ivlev,Ilya, AU - Hickman,Erin N, AU - McDonagh,Marian S, AU - Eden,Karen B, Y1 - 2017/03/13/ PY - 2016/09/27/received PY - 2017/02/21/accepted PY - 2017/02/07/revised PY - 2017/3/16/pubmed PY - 2018/4/4/medline PY - 2017/3/15/entrez KW - breast cancer screening KW - decision support techniques KW - intention KW - mammography KW - patient decision aid KW - utilization of screening mammography SP - 803 EP - 812 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 32 IS - 7 N2 - BACKGROUND: As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women's behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women's intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA. METHODS: We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended. RESULTS: We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04-2.13]; P = 0.03), particularly for younger (38-50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69-89 years) to discontinue screening. CONCLUSIONS: The use of BCS-PtDAs increased younger women's reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38-50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography. REGISTRATION: The protocol of this review is registered in the PROSPERO database, #CRD42016036695. SN - 1525-1497 UR - https://wwww.unboundmedicine.com/medline/citation/28289963/Use_of_patient_decision_aids_increased_younger_women's_reluctance_to_begin_screening_mammography:_a_systematic_review_and_meta_analysis_ L2 - https://dx.doi.org/10.1007/s11606-017-4027-9 DB - PRIME DP - Unbound Medicine ER -