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: 10097346
• 负责人: Laura D. Scherer
• 金额: $ 66.37万
• 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/10097346
• 关键词: Advisory Committees; Affective; Age; Agreement; Appointment; Attitude; Behavioral Sciences; Breast Cancer Detection; Cognitive; Communication; Decision Aid; Decision Making; Environment; Equilibrium; Evaluation; Family; Feeling; Focus Groups; Friends; Fright; Future; Guidelines; Harm Reduction; Health; Health Care Rationing; Healthcare; Interview; Knowledge; Lead; Longitudinal Studies; Longitudinal Surveys; Mammographic screening; Mammography; Medical; Patient Rights; Patients; Population; Prevalence; Preventive service; Primary Health Care; Probability; Randomized; Reaction; Recommendation; Research; Risk; Screening for cancer; Social Environment; Source; Suggestion; Surveys; Telephone; Testing; Time; Trust; United States; Woman; age group; base; cancer risk; care providers; comorbidity; distrust; empowered; empowerment; expectation; follow-up; improved; insight; interest; overtreatment; personalized approach; predicting response; preference; 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.

项目摘要/摘要 在适当水平的癌症风险中对合适患者进行癌症筛查可以挽救生命，但在最后几个 多年以来，许多专家团体脱离了乳腺X线摄影筛查建议，因为 对某些人群的净损害的证据。乳房X线摄影筛查的新建议突出显示 根据年龄，风险和合并症量身定制的方法，旨在最大程度地减少危害并吸引妇女 可以受益最大。例如，根据美国预防服务工作队的说法 指南，40-49岁的妇女应与医生交谈，并就是否要做出明智的选择 启动筛选。强烈促进所有女性的年度乳房X线照片的重点变化 40在这个年龄段中促进知情选择构成了医疗逆转，从某种意义上说 消息与过去的消息和人们的期望大不相同。而且，建议 明智的选择会引起某些女性的负面反应。许多妇女在被告知时表示难以置信 过度诊断和过度治疗，这是筛查的重大危害。基于风险的概念 筛查 - 即制定针对女性客观癌症风险量身定制的筛查计划 - 可以提高可疑 医疗配给。结果是一个微妙的情况，需要将证据传达给 女性以便她们可以做出明智的选择，但也需要以保持信誉和 信任目的地此健康消息逆转。在这项研究中，我们专注于四种有关响应的类型 妇女可能会对乳房X线摄影的反应表达：反应（即感知的操纵或 影响，例如“这是试图为医疗保健定型的”），自我豁免（例如，“这不适用于我”），难以置信 （例如，“您无法相信任何地方的所有研究”）和来源贬值（例如，“我不信任此源”）， 我们缩短了红色。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后果。在目标1中 我们将对40-49岁的妇女进行全国代表性调查，并测试情感和认知 红色反应的预测因素和筛查意图的后果。在AIM 2中，我们将进行 纵向调查并确定妇女如何参加证据预测共享决策 在即将到来的初级保健预约中进行乳房X线摄影，我们还将研究这些吸引力 随着时间的变化，受到妇女更广泛的社会环境的影响。在AIM 3中，我们将进行 访谈和焦点小组，以确定有关筛查更有效沟通的策略，以避免 负面的红色反应，并促进积极的回应，例如授权和对共同决策的渴望 制作。我们将修改现有的乳房X线摄影决策援助以纳入这些改进，然后 对这些改进进行随机试验测试，以提供初步证据表明它们会减少红色 并改善妇女对乳房X线摄影证据的积极反应。