The purpose of this quality improvement project was to pilot a clinical practice decision aid (DA) to provided evidence-based information about the harms and benefits of BCS directly to a community-based, convenience sample of women at average risk for breast cancer between the ages of 40 and 69. The specific aim of this project was to enhance preparedness for decision-making through the provision of a DA that is perceived as useful to the user. The online DA was evaluated by community participants for alignment with personal value and preference-based educational needs, usefulness and influence on personal beliefs about BCS.Method
An online, informational DA, ‘My Personal Decision’ (MPD), was constructed, with permission, from the Gotzsche, Hartling, Nielsen, & Brodersen (2012) leaflet, based on the findings of the systematic review by Gotzsche and Jorgensen (2013). The MPD was recorded using Powerpoint and was placed within a Qualtrics survey. This was piloted with a community-based convenience sample of 66 women in the spring of 2018. Information included in the MPD reviewed the definition of screening, benefit of lives saved from mammography, the harms of mammography screening including false alarms, more extensive surgery and after treatment, overdiagnosis/overtreatment, pain at the examination, and false reassurance. The numeric risk data in the DA was presented using icon arrays in a theater format.Results
Beliefs about harms vs. benefits of mammography screening, risk of over diagnosis, risk of overtreatment, and the usefulness of the DA in preparing for informed decision-making, along with structured and unstructured feedback questions about the DA were obtained. Participants (n=42) reported a change in response to the statement ‘There are more benefits than harms related to breast cancer screening (mammography).’ Prior to the DA, 36 women responded with strongly agree/agree that benefits of BCS outweighed harm. After completing the DA, 19 women continued to agree with this statement (p=0.0258, Fisher’s exact test). Most participants (81%) reported they agree/strongly agree with ‘This presentation helped me to make an informed decision about breast cancer screening.’ As well, 83% agreed/strongly agreed that ‘After watching this presentation, feel better prepared to make a decision about breast cancer screening.’ Further analysis will be provided at the presentation.Conclusions
Change in beliefs after evidence-based information about the harms and benefits of BCS was demonstrated in this small, community based sample. Evaluation feedback from the participants before and after use of the tool confirmed that MPD was helpful and enhanced preparedness for breast cancer screening decision-making. Overall, this project demonstrates that providing evidence-based information directly to women outside of a clinical consultation may be acceptable, informative, and perceived as valuable in the BCS decision-making process. These findings are important as understanding of evidence-based information is a fundamental element in the empowerment of the decision maker with the goal of informed decision making.