Braithwaite Dejana, Chicaiza Anthony, Lopez Katherine, Lin Kenneth W, Mishori Ranit, Karanth Shama D, Anton Stephen, Miller Kristen, Schonberg Mara A, Schoenborn Nancy L, O'Neill Suzanne C
University of Florida Health Cancer Center, Gainesville, FL, United States of America.
Georgetown University Medical Center, Washington, DC, United States of America.
PEC Innov. 2023 Dec;2. doi: 10.1016/j.pecinn.2023.100132. Epub 2023 Jan 31.
Supporting patient-clinician communication is key to implementing tailored, risk-based screening for older adults. Objectives of this multiphase mixed methods study were to identify factors that primary care clinicians consider influential when making screening mammography recommendations for women ≥ 75 years, develop a patient decision aid that incorporates these factors, and gather feasibility and acceptability from the patients' perspective.
Clinicians from a Mid-Atlantic practice network completed online surveys. Women in the same network completed surveys before and after receiving a tailored booklet that included information about the benefits and harms of screening for women ≥ 75 years, a breast cancer risk-estimate, and a question prompt list to support patient-clinician communication.
Clinicians (N = 21) were primarily women [57.1%] and practiced family medicine [81.0%]. They cited patients' age ≥ 75 years [95.4%], comorbidity [86.4%], functional status [77.3%], cancer family history [63.6%], U.S. Preventive Services Task Force guidelines [81.8%] and new research [77.3%] as factors influencing their recommendations. Fourteen women completed baseline surveys and received personalized decision aids (Mean age = 79.1 years). Eleven completed the post-intervention survey. All were satisfied with the booklet length, 81.8% found the booklet easy to understand and 72.7% helpful in decision-making Perceived lifetime breast cancer risk decreased significantly from pre- to post-intervention (p = 0.02).
Results suggest this decision aid, which incorporates key decisional factors from the clinician's perspective, is feasible and acceptable to patients.
A tailored decision aid booklet is innovative as it provides information on personalized risk and potential benefits and harms to older women considering screening.
支持患者与临床医生之间的沟通是对老年人实施基于风险的个性化筛查的关键。这项多阶段混合方法研究的目的是确定基层医疗临床医生在为75岁及以上女性进行乳腺钼靶筛查推荐时认为有影响的因素，开发一个纳入这些因素的患者决策辅助工具，并从患者角度收集其可行性和可接受性。
来自大西洋中部实践网络的临床医生完成在线调查。同一网络中的女性在收到一本量身定制的手册前后完成调查，该手册包含有关75岁及以上女性筛查的益处和危害的信息、乳腺癌风险估计以及支持患者与临床医生沟通的问题提示清单。
临床医生（N = 21）主要为女性[57.1%]，从事家庭医学[81.0%]。他们将患者年龄≥75岁[95.4%]、合并症[86.4%]、功能状态[77.3%]、癌症家族史[63.6%]、美国预防服务工作组指南[81.8%]和新研究[77.3%]列为影响其推荐的因素。14名女性完成了基线调查并收到了个性化决策辅助工具（平均年龄 = 79.1岁）。11名完成了干预后调查。所有人都对手册长度感到满意，81.8%的人认为手册易于理解，72.7%的人认为对手册在决策方面有帮助。从干预前到干预后，感知的终生乳腺癌风险显著降低（p = 0.02）。
结果表明，从临床医生角度纳入关键决策因素的这一决策辅助工具对患者来说是可行且可接受的。
一本量身定制的决策辅助手册具有创新性，因为它为考虑进行筛查的老年女性提供了个性化风险以及潜在益处和危害的信息。
