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

• Published in: Journal of general internal medicine : JGIM 2017-07, Vol.32 (7), p.803-812
• Main Authors: Ivlev, Ilya, Hickman, Erin N., McDonagh, Marian S., Eden, Karen B.
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Breasts; Cancer; Cancer screening; Clinical decision making; Clinical trials; Decision Making; Decision Support Techniques; Early Detection of Cancer - psychology; Early Detection of Cancer - trends; Female; Humans; Internal Medicine; Mammography; Mammography - psychology; Mammography - trends; Medical screening; Medicine; Medicine & Public Health; Meta-analysis; Motivation; Patient Participation - psychology; Patient Participation - trends; Randomized Controlled Trials as Topic - methods; Reluctance; Review Paper; Systematic review; Technology assessment; Womens health
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-017-4027-9

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