Understanding affective processing of scientific evidence to promote informed choice for breast cancer screening

了解科学证据的情感处理，以促进乳腺癌筛查的知情选择

• 批准号: 10548889
• 负责人: Laura D. Scherer
• 金额: $ 62.17万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548889
• 关键词: Affective; Age; Agreement; Appointment; Attitude; Behavioral Sciences; Breast Cancer Detection; Cognitive; Communication; Decision Aid; Decision Making; Diagnosis; Environment; Equilibrium; Evaluation; Family; Feeling; Focus Groups; Friends; Fright; Future; Guidelines; Harm Reduction; Health; Health Care Rationing; Interview; Knowledge; Longitudinal Studies; Longitudinal Surveys; Mammographic screening; Mammography; Medical; Patients; Persons; Population; Prevalence; Primary Care; Probability; Randomized; Reaction; Recommendation; Research; Risk; Screening for cancer; Social Environment; Source; Suggestion; Surveys; Telephone; Testing; Time; Trust; United States Preventative Services Task Force; Woman; age group; cancer risk; comorbidity; coping; distrust; empowerment; expectation; follow-up; improved; insight; interest; overtreatment; personalized approach; pilot test; predicting response; preference; primary care provider; response; screening; screening guidelines; shared decision making; social; theories

Project Summary/Abstract Cancer screening for the right patients at the right level of cancer risk can save lives, but over the last several years many expert groups have de-intensified mammography screening recommendations because of evidence of net harm for certain populations. Newer recommendations for mammography screening highlight a tailored approach based on age and risk and comorbidities, aiming to minimize harms and reach women who could benefit the most. For example, according to the United States Preventive Services Task Force guidelines, women age 40-49 should talk with their doctor and make an informed choice about whether to initiate screening. The change in emphasis from strongly promoting annual mammograms for all women over 40 to promoting informed choice in this age group constitutes a medical reversal, in the sense that this new message is very different from past messages and people’s expectations. Moreover, the recommendation for informed choice can elicit negative reactions in some women. Many women express disbelief when told about overdiagnosis and overtreatment, which are significant harms of screening. The notion of risk-based screening—that is, creating a screening plan tailored to a woman’s objective cancer risk—can raise suspicions of healthcare rationing. The result is a delicate situation in which there is need to convey the evidence to women so they can make an informed choice, but also a need to do it in a way that maintains credibility and trust despite this health message reversal. In this research we focus on four types of concerning responses that women may express in reaction to mammography evidence: Reactance (i.e. perceived manipulation or influence, e.g. “this is trying to ration healthcare”), self-Exemption (e.g., “this doesn’t apply to me”), Disbelief (e.g., “you can’t believe all the research anyway”), and Source derogation (e.g., “I don’t trust this source”), which we shorten to REDS. This research will identify affective and cognitive predictors of these reactions, and identify the consequences of these reactions for screening preferences and shared decision-making. In Aim 1 we will conduct a nationally representative survey of women age 40-49 and test affective and cognitive predictors of REDS reactions and consequences for screening intentions. In Aim 2 we will conduct a longitudinal survey and identify how women’s attitudes toward the evidence predicts shared decision making for mammography in an upcoming primary care appointment, and we will also examine how these attitudes change over time and are influence by women’s broader social environment. In Aim 3, we will conduct interviews and focus groups to identify strategies for communicating more effectively about screening, to avoid negative REDS responses, and promote positive responses like empowerment and desire for shared decision making. We will modify an existing mammography decision aid to incorporate these improvements, and then conduct randomized pilot tests of these improvements to provide preliminary evidence that they reduce REDS and improve women’s positive responses to mammography evidence.

项目概要/摘要 在适当的癌症风险水平下对适当的患者进行癌症筛查可以挽救生命，但在过去的几年中 多年来，许多专家组已经取消强化乳房 X 线摄影筛查建议，因为 对某些人群的净危害的证据强调了乳房X光检查筛查的新建议。 根据年龄、风险和合并症量身定制的方法，旨在最大限度地减少伤害并惠及以下女性 例如，根据美国预防服务工作组的说法， 根据指南，40-49 岁的女性应咨询医生，并就是否接受治疗做出明智的选择 开始大力强调对所有女性进行年度乳房X光检查的转变。 40 在这个年龄段促进知情选择构成了医学上的逆转，从某种意义上说，这种新的 消息与过去的消息和人们的期望有很大不同。 知情选择可能会引起一些女性的负面反应，许多女性在得知这一消息时表示不相信。 过度诊断和过度治疗，这是筛查的重大危害。 筛查（即根据女性的客观癌症风险制定筛查计划）可能会引起怀疑 医疗配给的结果是一个微妙的情况，需要向其传达证据。 女性能够做出明智的选择，但也需要以保持可信度和 尽管健康信息出现逆转，但仍保持信任。在这项研究中，我们重点关注四种类型的相关反应。 女性可能会对乳房 X 光检查证据表达的反应： 反应（即感知到的操纵或 影响，例如“这是试图配给医疗保健”），自我豁免（例如，“这不适用于我”），怀疑 （例如，“无论如何你都不能相信所有的研究”）和来源贬损（例如，“我不相信这个来源”）， 我们将其缩写为 REDS。这项研究将确定这些反应的情感和认知预测因素，以及 确定这些反应对筛选偏好和共同决策的影响，目标 1。 我们将对 40-49 岁女性进行全国代表性调查，测试情感和认知能力 REDS 反应的预测因素和筛查意图的后果。在目标 2 中，我们将进行一项研究。 纵向调查并确定女性对证据的态度如何预测共同决策 在即将到来的初级保健预约中进行乳房X光检查，我们还将研究这些态度如何 随着时间的推移而变化，并受到女性更广泛的社会环境的影响。在目标 3 中，我们将进行。 访谈和焦点小组以确定更有效地沟通筛查的策略，以避免 消极的 REDS 反应，并促进积极的反应，例如赋权和共同决策的愿望 我们将修改现有的乳房X光检查决策辅助以纳入这些改进，然后 对这些改进进行随机试点测试，以提供它们减少 REDS 的初步证据 并提高女性对乳房X光检查证据的积极反应。