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Development & evaluation of a web-based interactive decision aid for screening mammography
Upper Lobby
Development & evaluation of a web-based interactive decision aid for screening mammography
Associate Professor, Cornell
Introduction Conflicting breast cancer screening guidelines have created confusion and uncertainty among women in their 40’s, who are now advised to make individualized, informed decisions about when... Read more

Description

Introduction

Conflicting breast cancer screening guidelines have created confusion and uncertainty among women in their 40’s, who are now advised to make individualized, informed decisions about when to start and how often to have screening mammograms. Women and their physicians need tools to facilitate informed and personalized decisions about breast cancer screening.

Methods and Results

We developed a web-based, interactive decision aid (DA) called Breast Screening Decisions (BSD) for use by women ages 40-49 at average risk of breast cancer. BSD is based on the Ottowa Decision Support Framework, an evidence-based theory for guiding patients making health or social decisions. BSD meets 16 of 18 relevant International Patient Decision Aid Standards (IPDAS) criteria for DA quality. The BSD interface design reflects the results of usability testing with clinicians and female volunteers in the target age group.

BSD is a self-administered tool, accessible by personal computer, tablet or smart phone web browser. After users enter information about breast cancer risk factors, BSD provides personalized breast cancer risk estimates based on a validated clinical algorithm, and expected benefits and harms of screening mammography for women in their 40’s.  This information is presented in text and graphics, including a dynamic risk grid that allows subjects to visually compare the estimated breast cancer mortality associated with different screening schedules (annual vs. biennial, starting at 40 vs. starting at 50). In the final section of the tool, users manipulate interactive slide rules to clarify their personal values, beliefs and preferences regarding breast cancer and screening, and they can print and save a summary sheet to bring to a physician visit to inform a discussion about screening mammography.

BSD is currently being evaluated in a pilot study of women with scheduled preventive care visits at a large, university-affiliated women’s health practice.  To date, of 44 women who accessed BSD prior to their visit, 21 entered information about breast cancer risk factors.  All eleven women who completed a brief survey after viewing the entire decision aid expressed agreement or strong agreement 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.

Conclusions

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 with 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 breast cancer screening. If it proves feasible and acceptable to patients and providers and has a favorable impact on the decision-making process, BSD could be integrated with electronic medical records to improve data capture for individualized breast cancer risk assessment and with secure, online patient portals to improve accessibility.

 

Margaret (Peggy) Polaneczky, MD is a practicing gynecologist and Associate Professor of Obstetrics & Gynecology at Weill Medical College of Cornell University in New York City. She has been blogging about women’s health, food and life in NYC since 2006 at The Blog that Ate Manhattan (http://tbtam.com).  Overwhelmingly positive public response to her blog posts explaining the USPSTF Mammogram Screening Guidelines led her to create Breast Screening Decisions, an online decision aid for women and their clinicians to use in making decisions about screening mammography. She is currently collaborating to develop online decision aids related to Down’s syndrome screening and lung cancer screening.

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