Bourmaud Aurelie, Soler-Michel Patricia, Oriol Mathieu, Regnier Véronique, Tinquaut Fabien, Nourissat Alice, Bremond Alain, Moumjid Nora, Chauvin Franck
Hygée Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France.
EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France.
Oncotarget. 2016 Mar 15;7(11):12885-92. doi: 10.18632/oncotarget.7332.
Controversies regarding the benefits of breast cancer screening programs have led to the promotion of new strategies taking into account individual preferences, such as decision aid. The aim of this study was to assess the impact of a decision aid leaflet on the participation of women invited to participate in a national breast cancer screening program. This Randomized, multicentre, controlled trial. Women aged 50 to 74 years, were randomly assigned to receive either a decision aid or the usual invitation letter. Primary outcome was the participation rate 12 months after the invitation. 16 000 women were randomized and 15 844 included in the modified intention-to-treat analysis. The participation rate in the intervention group was 40.25% (3174/7885 women) compared with 42.13% (3353/7959) in the control group (p = 0.02). Previous attendance for screening (RR = 6.24; [95%IC: 5.75-6.77]; p < 0.0001) and medium household income (RR = 1.05; [95%IC: 1.01-1.09]; p = 0.0074) were independently associated with attendance for screening. This large-scale study demonstrates that the decision aid reduced the participation rate. The decision aid activate the decision making process of women toward non-attendance to screening. These results show the importance of promoting informed patient choices, especially when those choices cannot be anticipated.
关于乳腺癌筛查项目益处的争议促使人们推广考虑个体偏好的新策略，比如决策辅助工具。本研究旨在评估一份决策辅助传单对受邀参加全国乳腺癌筛查项目的女性参与情况的影响。这是一项随机、多中心对照试验。年龄在50至74岁的女性被随机分配，分别接受决策辅助工具或普通邀请函。主要结局指标是邀请发出12个月后的参与率。16000名女性被随机分组，15844名纳入改良意向性分析。干预组的参与率为40.25%（7885名女性中有3174名），而对照组为42.13%（7959名女性中有3353名）（p = 0.02）。既往参加过筛查（RR = 6.24；[95%置信区间：5.75 - 6.77]；p < 0.0001）和中等家庭收入（RR = 1.05；[95%置信区间：1.01 - 1.09]；p = 0.0074）与参加筛查独立相关。这项大规模研究表明，决策辅助工具降低了参与率。决策辅助工具促使女性做出不参加筛查的决策。这些结果显示了促进患者做出明智选择的重要性，尤其是当这些选择难以预料时。
