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Does a decision aid improve informed choice in mammography screening? Results from a randomised controlled trial

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  • Maren Reder
  • Petra Kolip

Abstract

Background: Decision aids can support informed choice in mammography screening, but for the German mammography screening programme no systematically evaluated decision aid exists to date. We developed a decision aid for women invited to this programme for the first time based on the criteria of the International Patient Decision Aids Standards Collaboration. Objective: To determine whether a decision aid increases informed choice about mammography screening programme participation. Methods: A representative sample of 7,400 women aged 50 was drawn from registration offices in Westphalia-Lippe, Germany. Women were randomised to receive usual care (i.e., the standard information brochure sent with the programme’s invitation letter) or the decision aid. Data were collected online at baseline, post-intervention, and 3 months follow-up. The primary outcome was informed choice. Secondary outcomes were the constituents of informed choice (knowledge, attitude, intention/uptake), decisional conflict, decision regret, and decision stage. Outcomes were analysed using latent structural equation models and χ2-tests. Results: 1,206 women participated (response rate of 16.3%). The decision aid increased informed choice. Women in the control group had lower odds to make an informed choice at post-intervention (OR 0.26, 95% CI 0.18-0.37) and at follow-up (OR 0.66, 95% CI 0.46-0.94); informed choices remained constant at 30%. This was also reflected in lower knowledge and more decisional conflict. Post-intervention, the uptake intention was higher in the control group, whereas the uptake rate at follow-up was similar. Women in the control group had a more positive attitude at follow-up than women receiving the decision aid. Decision regret and decision stage were not influenced by the intervention. Conclusion: This paper describes the first systematic evaluation of a newly developed decision aid for the German mammography screening programme in a randomised controlled trial. Our decision aid proved to be an effective tool to enhance the rate of informed choice and was made accessible to the public. Trial registration: German Clinical Trials Register DRKS00005176.

Suggested Citation

  • Maren Reder & Petra Kolip, 2017. "Does a decision aid improve informed choice in mammography screening? Results from a randomised controlled trial," PLOS ONE, Public Library of Science, vol. 12(12), pages 1-19, December.
    • Handle: RePEc:plo:pone00:0189148
    DOI: 10.1371/journal.pone.0189148
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    References listed on IDEAS

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    1. Dafina Petrova & Rocio Garcia-Retamero & Edward T. Cokely, 2015. "Understanding the Harms and Benefits of Cancer Screening," Medical Decision Making, , vol. 35(7), pages 847-858, October.
    2. Wendy L. Nelson & Paul K. J. Han & Angela Fagerlin & Michael Stefanek & Peter A. Ubel, 2007. "Rethinking the Objectives of Decision Aids: A Call for Conceptual Clarity," Medical Decision Making, , vol. 27(5), pages 609-618, September.
    3. Garcia-Retamero, Rocio & Galesic, Mirta, 2010. "Who proficts from visual aids: Overcoming challenges in people's understanding of risks," Social Science & Medicine, Elsevier, vol. 70(7), pages 1019-1025, April.
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    1. Ritchie, David & Van Hal, Guido & Van den Broucke, Stephan, 2020. "How is informed decision-making about breast cancer screening addressed in Europe? An international survey of 28 countries," Health Policy, Elsevier, vol. 124(9), pages 1017-1031.

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