Davey Claire, White Victoria, Gattellari Melina, Ward Jeanette E
Centre for Behavioural Research in Cancer, The Cancer Council Victoria.
Aust N Z J Public Health. 2005 Feb;29(1):69-77. doi: 10.1111/j.1467-842x.2005.tb00752.x.
To explore women's reactions to 'informed choice' in mammographic screening.
Telephone interviews with a convenience sample of 106 women aged 45-70 years recruited from general practices in Sydney.
Many (42%) women preferred an active role in decision-making. Respondents had low scores for 'uncertainty' and 'factors contributing to uncertainty' in response to explicit questions about the decision to have mammographic screening. Yet respondents indicated significantly greater willingness to have a test when the benefit of a 'new' screening test for breast cancer was expressed as relative risk reduction (RRR) (88%) than either absolute risk reduction (ARR) (78%) (McNemar's test: chi(2)1=7.14, p=0.013) or all-cause mortality (53%) (McNemar's test: chi(2)1=35.1, p<0.01). Significantly more respondents considered information about ARR 'new' to them (65%) compared with RRR information (30%) (McNemar's test: chi(2)1=25.83, p<0.01).
As mammographic screening exposes well women to potential harms for an overall population benefit, it is challenging to ensure 'informed choice'. Our results suggest women will likely appreciate individual consultations as the context in which to share complex information that women in our study agreed they need to know about mammographic screening. Our results also demonstrate that women's willingness as individuals to participate in mammographic screening is influenced by 'framing effect'. Hence, the quantitative content of decision aids to promote 'informed choice' must be comprehensive and balanced.
探讨女性对乳腺钼靶筛查中“知情选择”的反应。
对从悉尼普通诊所招募的106名年龄在45 - 70岁的女性进行电话访谈，样本为便利抽样。
许多（42%）女性倾向于在决策中发挥积极作用。在针对是否进行乳腺钼靶筛查的明确问题的回答中，受访者在“不确定性”和“导致不确定性的因素”方面得分较低。然而，当将乳腺癌“新”筛查试验的益处表述为相对风险降低（RRR）时（88%），受访者表示进行检查的意愿明显高于绝对风险降低（ARR）时（78%）（麦克内马尔检验：χ²1 = 7.14，p = 0.013）或全因死亡率时（53%）（麦克内马尔检验：χ²1 = 35.1，p < 0.01）。与RRR信息（30%）相比，显著更多的受访者认为ARR信息对她们来说是“新的”（65%）（麦克内马尔检验：χ²1 = 25.83，p < 0.01）。
由于乳腺钼靶筛查是为了总体人群利益而让健康女性面临潜在危害，确保“知情选择”具有挑战性。我们的结果表明，女性可能会重视个人咨询，将其作为分享复杂信息的背景，我们研究中的女性一致认为她们需要了解乳腺钼靶筛查相关信息。我们的结果还表明，女性作为个体参与乳腺钼靶筛查的意愿受“框架效应”影响。因此，促进“知情选择”的决策辅助工具的定量内容必须全面且平衡。
