Department of Public Health, Aarhus University, Aarhus, Denmark.
Social & Health Services and Labour Market, DEFACTUM, Aarhus, Denmark.
Med Decis Making. 2023 May;43(4):403-416. doi: 10.1177/0272989X231152830. Epub 2023 Feb 3.
Informed decision making is recommended in breast cancer screening. Decision aids with balanced information on harms and benefits are recommended to support informed decision making. However, informed screening decision making may be challenged by overly positive attitudes toward cancer screening. We hypothesized that a substantial proportion of Danish women would want to participate in screening regardless of the presented information. Therefore, we aimed to estimate the prevalence of Danish women wanting to participate in a hypothetical breast cancer screening offering no reduction in breast cancer mortality but potential harms related to unnecessary treatment.
In a cross-sectional study, we invited a random sample of 751 women in the nonscreening population aged 44 to 49 y in the Central Denmark Region to an online questionnaire using the official digital mailbox system. The questionnaire included a description of a hypothetical screening and questions about thoughts on breast cancer, health literacy, and questions on the assessment of the hypothetical screening including intended participation, understanding, and belief in information. Data were linked to register data on sociodemographic factors.
In total, 43.0% (323/751) responded to the questionnaire. Of these, 247 (82.3% [95% confidence interval: 77.5-86.5]) wanted to participate in the hypothetical breast cancer screening (participation group). More than two-thirds in both the participation group and nonparticipation group seemed to understand the presented information. Half of the women who understood the information disbelieved it.
Exceeding our expectations, a majority of women wanted to participate in a hypothetical screening with potential harms but no reduction in breast cancer mortality. A large proportion understood but disbelieved the screening information. This could indicate that Danish women make their screening decisions based on beliefs rather than presented screening information. This study was registered at ClinicalTrials.gov (Identifier: NCT04509063).
The majority of Danish women wanted to participate in a hypothetical breast cancer screening with potential harms related to unnecessary treatment but no reduction in mortality.A large proportion of women understood but disbelieved the hypothetical screening information.Informed decision making may be challenging when women disbelieve the information they receive.Enthusiasm for cancer screening and potential disbelief in information are important factors when developing and improving screening information and invitation.
在乳腺癌筛查中推荐进行知情决策。建议使用具有危害和益处平衡信息的决策辅助工具来支持知情决策。然而，对癌症筛查的过度积极态度可能会对知情筛查决策构成挑战。我们假设丹麦有相当一部分女性无论提供何种信息都希望参加筛查。因此，我们旨在估计丹麦女性希望参加一种假设的乳腺癌筛查的比例，这种筛查不会降低乳腺癌死亡率，但可能会带来与不必要治疗相关的危害。
在一项横断面研究中，我们通过丹麦中央大区的非筛查人群中年龄在 44 至 49 岁的随机抽样，邀请 751 名女性使用官方数字邮箱系统在线填写问卷。问卷包括对假设性筛查的描述，以及对乳腺癌、健康素养的看法，以及对假设性筛查的评估问题，包括参与意向、理解和对信息的信任。数据与社会人口因素登记数据相关联。
共有 751 名女性中的 43.0%（323 名）回复了问卷。其中，247 名（82.3%[95%置信区间：77.5-86.5%]）希望参加假设性乳腺癌筛查（参与组）。参与组和非参与组中超过三分之二的人似乎都理解了所提供的信息。理解信息的女性中有一半人不相信信息。
出乎我们的意料，大多数女性希望参加一种具有潜在危害但不会降低乳腺癌死亡率的假设性筛查。相当一部分人理解但不相信筛查信息。这可能表明丹麦女性的筛查决策是基于信念而不是提供的筛查信息。本研究已在 ClinicalTrials.gov 注册（标识符：NCT04509063）。
大多数丹麦女性希望参加一种具有潜在危害的假设性乳腺癌筛查，这些危害与不必要的治疗有关，但不会降低死亡率。相当一部分女性理解但不相信假设性筛查信息。当女性不相信他们收到的信息时，知情决策可能会受到挑战。对癌症筛查的热情和对信息的潜在不信任是开发和改进筛查信息和邀请的重要因素。
