Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA, USA.
Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
J Health Commun. 2020 Dec 1;25(12):951-961. doi: 10.1080/10810730.2020.1845256. Epub 2021 Jan 17.
Starting breast cancer screening at age 40 versus 50 may increase potential harms frequency with a small mortality benefit. Younger women's screening decisions, therefore, may be complex. Shared decision-making (SDM) is recommended for women under 50 and may support women under 55 for whom guidelines vary. How women with limited health literacy (LHL) approach breast cancer screening decision-making is less understood, and most SDM tools are not designed with their input. This phenomenological study sought to characterize mammography counseling experiences among women with LHL and primary care providers (PCPs). Women ages 40-54 with LHL who had no history of breast cancer or mammogram within 9 months were approached before a primary care visit at a safety-net hospital. PCPs at this site were invited to participate. Qualitative interviews explored mammography counseling experiences. Patients also reviewed sample information materials. A constant comparison technique generated four themes salient to 25 patients and 20 PCPs: addressing family history versus comprehensive risk assessment; potential mammography harms discussions; information delivery preferences; and integrating pre-visit information tools. Findings suggest that current counseling techniques may not be responsive to patient-identified needs. Opportunities exist to improve how mammography information is shared and increase accessibility across the health literacy spectrum.
从 40 岁开始进行乳腺癌筛查与从 50 岁开始相比，可能会增加潜在危害的发生频率，但死亡率获益较小。因此，年龄较轻的女性的筛查决策可能较为复杂。建议对 50 岁以下的女性进行共同决策（SDM），并且可能会支持指南有所不同的 55 岁以下的女性。对于健康素养有限（LHL）的女性如何进行乳腺癌筛查决策的了解较少，并且大多数 SDM 工具并非基于其输入而设计。这项现象学研究旨在描述 LHL 女性和初级保健提供者（PCP）的乳房 X 光检查咨询体验。在一家安全网医院的初级保健就诊之前，邀请了无乳腺癌病史或在 9 个月内未进行乳房 X 光检查的年龄在 40-54 岁之间且健康素养有限的女性参加。邀请了该地点的 PCP 参与。定性访谈探讨了乳房 X 光检查咨询的经验。患者还审查了示例信息材料。恒定比较技术生成了 25 名患者和 20 名 PCP 共有的四个主题：家族史与综合风险评估；潜在的乳房 X 光危害讨论；信息传递偏好；以及整合就诊前信息工具。研究结果表明，目前的咨询技术可能无法满足患者确定的需求。有机会改善乳房 X 光信息的共享方式，并提高整个健康素养范围内的可及性。
