Messaging Strategies to Reduce Breast Cancer Over-Screening in Older Women

减少老年女性乳腺癌过度筛查的信息传递策略

• 批准号: 10592067
• 负责人: Nancy Schoenborn
• 金额: $ 16.36万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592067
• 关键词: Address; Administrative Supplement; Age; Area; Attitude; Behavioral; Belief; Beneficence; Bioethics; Bioethics Consultants; Breast Cancer Detection; COVID-19 pandemic; Caring; Case Study; Clinical Treatment; Communication Tools; Critiques; Deimplementation; Diagnosis; Elderly; Emotional; Equilibrium; Ethical Issues; Ethics; Family; Foundations; Friends; Future; Guidelines; Harm Reduction; Health Professional; Healthcare; Individual; Intervention; Interview; Knowledge; Life; Life Expectancy; Literature; Malignant Neoplasms; Mammographic screening; Misinformation; Morals; Morbidity - disease rate; Nonmaleficence; Outcome; Parents; Patients; Persuasive Communication; Policies; Public Health; Reaction; Recommendation; Research; Research Personnel; Screening for cancer; Source; Surveys; Techniques; Testing; Woman; behavior change; clinical care; health communication; implementation efforts; malignant breast neoplasm; mortality; novel; older patient; older women; overtreatment; parent grant; parent project; patient-clinician communication; routine screening; screening; smoking cessation; theories; tool; uptake

PROJECT SUMMARY This administrative supplement proposal focuses on bioethics research around the use of persuasion in health communication, specifically in the context of reducing breast cancer over-screening. Mammography screening may decrease breast cancer mortality and morbidity but the potential benefits are often delayed for many years while significant harms can occur in the short term. The harms of routine screening outweigh the benefits among older women with limited life expectancies, but many of these women continue to be screened, highlighting the need for interventions to promote appropriate screening cessation and reduce over-screening in older women. Our project (R01AG066741) is studying the novel use of messaging interventions, via clinician-patient communication and other sources (family, friends, and the media), to reduce over-screening. Numerous health communication strategies, such as establishing credibility, using emotional appeals, and using stories, are inherently persuasive and used to change behaviors. The parent R01 project plans to test various messages employing such persuasive strategies but the potential ethical implications are unclear. One perspective asserts that using persuasion may be manipulative and threat patient autonomy while others argue that it is essential to guide patients towards options that promote benefits (beneficence) and minimize harms (non-maleficence). It is not clear at what point across the benefits/harms balance spectrum it may be ethically acceptable to shift from informing to persuading or what forms of persuasion are acceptable in the context of reducing over-screening. This supplement project aims to build upon the parent project to address ethical issues around using persuasion to reduce breast cancer over-screening. First, we will examine older women’s moral beliefs and values on this topic. We propose both qualitative in-depth interviews of 30 older women (Aim 1) and quantitative surveys of 3000 older women (Aim 2), where the latter leverages a nationally representative online survey that is already planned as part of the parent project. Then, we will convene an expert panel of bioethicists, clinicians, health communication and cancer screening researchers. The panel will deliberate and reflect upon the empirical results from Aims 1 and 2, existing literature on breast cancer screening and messaging, and the competing ethical principles of patient autonomy and beneficence/non-maleficence, to make recommendations on how to use persuasion in de-implementing over-screening (Aim 3). The proposed project will build on the existing R01 and 1) identify messages that are not only effective for reducing over-screening but are also ethically acceptable, and 2) develop an ethical framework to guide the next-step messaging intervention. More broadly, the results will help address the appropriate and effective use of health communication tools in both clinical care and public health in the context of de-implementation.

项目概要 该行政补充提案侧重于围绕说服的使用的生物伦理学研究 健康沟通，特别是在减少乳腺癌过度筛查方面。 筛查可能会降低乳腺癌死亡率和发病率，但潜在的益处往往会被延迟 常规筛查的危害超过了其危害。 预期寿命有限的老年妇女受益，但其中许多妇女仍在接受筛查， 强调需要采取干预措施，促进适当停止筛查并减少过度筛查 我们的项目（R01AG066741）正在研究信息干预的新用途，通过 临床医生与患者之间的沟通以及其他来源（家人、朋友和媒体），以减少过度筛查。 许多健康沟通策略，例如建立可信度、利用情感诉求、 并使用故事，本质上是有说服力的，可以用来改变行为。母 R01 项目计划这样做。 使用这种说服策略测试各种信息，但潜在的道德影响尚不清楚。 一种观点认为，使用说服可能具有操纵性，并威胁患者的自主权，而另一些观点则认为 认为有必要引导患者选择能够促进益处（仁慈）并最大限度地减少损失的选择。 目前还不清楚它可能处于利益/危害平衡范围的哪个点。 从告知转向说服的转变在道德上是可以接受的，或者什么形式的说服是可以接受的 减少过度筛查的背景。 该补充项目旨在以父项目为基础，解决有关使用的道德问题 首先，我们将检查老年妇女的道德信念和态度。 我们建议对 30 名老年女性进行定性深入访谈（目标 1）。 对 3000 名老年妇女进行定量调查（目标 2），后者利用具有全国代表性的在线调查 已计划作为父项目一部分的调查 然后，我们将召集一个专家小组。 生物伦理学家、赞助人、健康传播和癌症筛查研究人员将保持谨慎和谨慎。 反思目标 1 和 2 的实证结果、乳腺癌筛查的现有文献以及 信息传递，以及患者自主和仁慈/非恶意的竞争道德原则，以 就如何利用说服手段消除过度筛查提出建议（目标 3）。 拟议的项目将建立在现有 R01 的基础上，并且 1) 确定不仅有效的信息 以减少过度筛查，但在道德上也是可以接受的，并且 2）制定道德框架来指导 更广泛地说，结果将有助于解决适当和有效的使用问题。 在取消实施的背景下，临床护理和公共卫生中的健康传播工具的数量。