Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
JAMA Netw Open. 2024 Aug 1;7(8):e2428700. doi: 10.1001/jamanetworkopen.2024.28700.
Many older women are screened for breast cancer beyond guideline-recommended thresholds. Messaging holds promise to reduce overscreening.
To investigate the effect of a message on older women's support for and intentions of stopping breast cancer screening.
DESIGN, SETTING, AND PARTICIPANTS: A 2-wave randomized clinical online survey trial using a nationally representative online panel was performed from May 12 to June 19, 2023. Women 65 years or older without breast cancer were eligible to participate.
A pilot-tested breast cancer screening cessation message delivered to a hypothetical older woman with serious illnesses and functional impairment. The message was described as from 1 of 3 sources (clinician, news story, or family member). Participants were randomized into 4 groups: no message (group 1 [control]), a single message from a clinician at wave 1 and no message at wave 2 (group 2), a message from a news story (wave 1) and a clinician (wave 2) (group 3), and a message from a family member (wave 1) and a clinician (wave 2) (group 4).
Support for stopping screening in the hypothetical older woman (primary) and screening intentions for oneself (secondary) were assessed on 7-point scales, with higher values indicating stronger support for and intentions to stop screening. Means were compared using analysis of variance. The message effect on screening intentions among participants 75 years or older and those with life expectancy of less than 10 years were also explored.
A total of 3051 women participated in wave 1 of the trial. The mean (SD) age was 72.8 (5.9) years; 272 (8.9%) were non-Hispanic Black and 2506 (82.1%) were non-Hispanic White. Of these women, 2796 (91.6%) completed wave 2. Group 2 had significantly higher support for screening cessation in the hypothetical patient at wave 2 (mean score, 3.14 [95% CI, 2.99-3.29]) compared with group 1 (mean score, 2.68 [95% CI, 2.54-2.82]; P < .001). The effect was even stronger in group 3 (mean score, 4.23 [95% CI, 4.09-4.38]) and group 4 (mean score, 4.12 [95% CI, 3.97-4.27]) compared with both groups 1 and 2 (all P < .001). Message effects on self-screening intentions followed a similar pattern, with larger effects among participants 75 years or older or with limited life expectancy.
In this randomized clinical trial, a breast cancer screening cessation message significantly increased older women's support for and intentions of screening cessation. The strongest effects were observed when the message was delivered over time from multiple sources. Future work needs to engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior.
ClinicalTrials.gov Identifier: NCT05821023.
许多老年女性的乳腺癌筛查超出了指南推荐的阈值。信息传递有望减少过度筛查。
调查信息对老年女性支持和停止乳腺癌筛查意愿的影响。
设计、设置和参与者：2023 年 5 月 12 日至 6 月 19 日，采用全国代表性在线小组进行了 2 波随机临床在线调查试验。年龄在 65 岁或以上且没有乳腺癌的女性有资格参加。
对一位患有严重疾病和功能障碍的虚构老年女性进行了经过试点测试的乳腺癌筛查停止信息传递。该信息被描述为来自 3 个来源之一（临床医生、新闻报道或家庭成员）。参与者被随机分为 4 组：无信息（第 1 组[对照组]）、第 1 波来自临床医生的单一信息且第 2 波无信息（第 2 组）、来自新闻报道（第 1 波）和临床医生（第 2 波）的信息（第 3 组），以及来自家庭成员（第 1 波）和临床医生（第 2 波）的信息（第 4 组）。
对假设的老年女性停止筛查的支持（主要）和自身筛查的意愿（次要）进行了 7 点量表评估，得分越高表示对停止筛查的支持和意愿越强。使用方差分析比较均值。还探讨了消息对 75 岁及以上参与者和预期寿命不足 10 年的参与者的筛查意愿的影响。
共有 3051 名女性参加了试验的第 1 波。平均（SD）年龄为 72.8（5.9）岁；272 人（8.9%）是非西班牙裔黑人，2506 人（82.1%）是非西班牙裔白人。在这些女性中，有 2796 人（91.6%）完成了第 2 波。与第 1 组（平均得分 2.68 [95%CI，2.54-2.82]）相比，第 2 组（平均得分 3.14 [95%CI，2.99-3.29]）对假设患者的筛查停止支持明显更高（P<0.001）。第 3 组（平均得分 4.23 [95%CI，4.09-4.38]）和第 4 组（平均得分 4.12 [95%CI，3.97-4.27]）与第 1 组和第 2 组相比，效果甚至更强（均 P<0.001）。消息对自我筛查意愿的影响也遵循类似的模式，在 75 岁及以上或预期寿命有限的参与者中效果更大。
在这项随机临床试验中，乳腺癌筛查停止信息显著增加了老年女性对筛查停止的支持和意愿。当消息来自多个来源且随时间传递时，效果最强。未来的工作需要让潜在的消息来源参与进来，以研究多层次信息传递策略的可行性和可接受性及其对筛查行为的影响。
ClinicalTrials.gov 标识符：NCT05821023。
