School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Cancer. 2021 Dec 1;127(23):4455-4463. doi: 10.1002/cncr.33857. Epub 2021 Aug 10.
To help inform screening decisions, a mammography screening decision aid (DA) for women aged 75 years and older was tested in a cluster randomized clinical trial of 546 women. DA use increased women's knowledge of the benefits and harms of mammography and lowered screening rates. In the current study, the objective was to examine whether participants' views of the DA and/or its effects differed by educational attainment.
A secondary analysis was conducted of 283 women who received the DA before a personal care provider (PCP) visit during the trial to examine the acceptability of the DA and its effects on knowledge of the benefits and harms of mammography, screening intentions, and receipt of screening by educational attainment. Adjusted analyses accounted for clustering by PCP.
Of the 283 participants, 43% had a college education or less. Regardless of educational attainment, 87.2% found the DA helpful. Women with lower educational attainment were less likely to understand all of the DA's content (46.3% vs 67.5%; P < .001), had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; P < .001), and were less likely to lower screening intentions (adjusted percentage, 11.4% vs 19.4%; P = .01). Receipt of screening did not differ by educational attainment.
A mammography DA for women aged 75 years and older was helpful to women regardless of their educational attainment; however, those with a college degree or greater understood the DA and, possibly as a result, lowered their screening intentions. Future studies need to examine how to better support informed decision making around mammography screening in older women with lower educational attainment.
The authors examined data from a previous study to learn the effects of a mammography decision aid (DA) for women aged 75 years and older according to their level of education. Overall, women found the DA helpful, but women with lower educational attainment found it harder to understand the benefits and harms of mammography screening and were less likely to lower their screening intentions than women with a college degree. The findings suggest that women aged 75 years and older who have lower educational attainment may need an even lower literacy DA and/or more support from health care professionals.
为了帮助制定筛查决策，我们对 546 名年龄在 75 岁及以上的女性进行了一项针对乳腺 X 线筛查决策辅助工具（DA）的集群随机临床试验，结果显示 DA 可提高女性对乳腺 X 线筛查的益处和危害的认识，并降低筛查率。在当前的研究中，我们的目的是研究参与者对 DA 的看法及其效果是否因受教育程度而异。
对 283 名在试验期间接受过 DA 的女性进行了二次分析，这些女性在接受个人护理提供者（PCP）就诊前接受了 DA，以检验 DA 的可接受性及其对女性对乳腺 X 线筛查的益处和危害的认识、筛查意向以及受教育程度对筛查的影响。调整分析考虑了 PCP 的聚类。
在 283 名参与者中，43%的人接受过大学教育或以下教育。无论受教育程度如何，87.2%的女性认为 DA 有帮助。受教育程度较低的女性不太可能理解 DA 的所有内容（46.3%对 67.5%；P<0.001），对乳腺 X 线筛查的益处和危害的了解也较少（调整后的平均标准误差知识评分，7.1±0.3 对 8.1±0.3；P<0.001），降低筛查意向的可能性也较小（调整后的百分比，11.4%对 19.4%；P=0.01）。受教育程度对接受筛查的影响无差异。
针对 75 岁及以上女性的乳腺 X 线筛查 DA 对所有女性都有帮助，无论其受教育程度如何；然而，受教育程度较高的女性对 DA 的理解能力更强，可能因此降低了她们的筛查意向。未来的研究需要探讨如何更好地支持文化程度较低的老年女性做出关于乳腺 X 线筛查的知情决策。
作者对之前的一项研究的数据进行了检查，以了解乳腺 X 线筛查决策辅助工具（DA）对 75 岁及以上女性的影响是否与她们的教育程度有关。总的来说，女性发现 DA 很有帮助，但受教育程度较低的女性发现，她们更难理解乳腺 X 线筛查的益处和危害，而且与受大学教育的女性相比，她们降低筛查意向的可能性更小。这些发现表明，受教育程度较低的 75 岁及以上女性可能需要一个更低文化程度的 DA，以及来自医疗保健专业人员更多的支持。
