Department of Public Health, Aarhus University, Aarhus, Denmark.
Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.
Med Decis Making. 2024 Aug;44(6):674-688. doi: 10.1177/0272989X241248142. Epub 2024 May 4.
At mammography screening invitation, the Danish Health Authority recommends women aged 50 to 69 y make an informed decision about whether to be screened. Previous studies have shown that women have very positive attitudes about screening participation. Therefore, we hypothesized that Danish women may already have decided to participate in breast cancer screening prior to receiving their screening invitation at age 50 y.
We invited a random sample of 2,952 Danish women aged 44 to 49 y (prescreening age) to complete an online questionnaire about barriers to informed screening decision making using the official digital mailbox system in Denmark. We asked participants about their screening intentions using 3 different questions to which women were randomized: screening presented 1) as an opportunity, 2) as a choice, and 3) as an opportunity plus a question about women's stage of decision making. All women completed questions about background characteristics, intended participation in the screening program, use and impact of screening information, and preferences for the decision-making process. Data were linked to sociodemographic register data.
A total of 790 (26.8%) women participated in the study. Herein, 97% (95% confidence interval: 96%-98%) reported that they wanted to participate in breast cancer screening when invited at age 50 y. When presented with the choice compared with the opportunity framing, more women rejected screening. When asked about their stage of decision making, most (87%) had already made a decision about screening participation and were unlikely to change their mind.
In our study, almost all women of prescreening age wanted to participate in breast cancer screening, suggesting that providing information at the time of screening invitation may be too late to support informed decision making.
Almost all women of prescreening age (44-49 y) in our study wanted to participate in the Danish national mammography screening program starting at age 50 y.Early decision making represents a barrier for informed decision making as women in this study had intentions to participate in breast cancer screening prior to receiving an official screening invitation, and therefore, providing information at the time of screening invitation may be too late to support informed decision making.Very few women rejected screening participation; however, more women rejected screening when the information was framed as an active choice between having or declining breast cancer screening (continue with usual care) compared with presenting only the option of screening with no description of the alternative.Two-thirds of women reading the screening information in this study had unchanged attitudes toward screening after reading the presented information.
在乳腺 X 光筛查邀请时，丹麦卫生局建议 50 至 69 岁的女性做出知情决策。既往研究表明，女性对筛查参与持非常积极的态度。因此，我们假设丹麦女性在 50 岁收到筛查邀请之前可能已经决定参加乳腺癌筛查。
我们邀请了 2952 名年龄在 44 至 49 岁（筛查前年龄）的丹麦女性参加一项在线问卷调查，使用丹麦官方数字邮箱系统了解影响知情决策的障碍。我们使用 3 个不同的问题询问参与者的筛查意向，这些问题对女性进行了随机分组：筛查呈现为 1）机会，2）选择，3）机会加女性决策阶段的问题。所有女性都完成了关于背景特征、计划参与筛查计划、筛查信息的使用和影响以及对决策过程偏好的问题。数据与社会人口统计学登记数据相关联。
共有 790 名（26.8%）女性参加了这项研究。其中，97%（95%置信区间：96%-98%）的女性报告说，当她们在 50 岁时收到邀请时，希望参加乳腺癌筛查。与机会框架相比，当提供选择时，更多的女性拒绝筛查。当被问及她们的决策阶段时，大多数（87%）已经做出了关于筛查参与的决定，不太可能改变主意。
在我们的研究中，几乎所有的筛查前年龄的女性都希望参加乳腺癌筛查，这表明在筛查邀请时提供信息可能为时已晚，无法支持知情决策。
我们的研究中，几乎所有的筛查前年龄（44-49 岁）的女性都希望参加丹麦全国性的乳腺 X 光筛查计划，该计划从 50 岁开始。早期决策是知情决策的障碍，因为本研究中的女性在收到正式筛查邀请之前就有参加乳腺癌筛查的意向，因此，在筛查邀请时提供信息可能为时已晚，无法支持知情决策。很少有女性拒绝参加筛查；然而，与仅提供筛查选择而不描述替代方案相比，当信息被框定为主动选择是否进行乳腺癌筛查（继续接受常规护理）时，更多的女性拒绝筛查。在阅读本研究中的筛查信息后，三分之二的女性对筛查的态度没有改变。
