Heather M. Davey

Helping women make choices about mammography screening : An online randomized trial of a decision aid for 40-year-old women

OBJECTIVE To evaluate the effect of a decision aid (DA) on womens knowledge of the benefits and harms of screening and on their ability to make an informed decision. METHODS An online randomized controlled trial among 321 women aged 38-45 years was conducted. Participants were randomized to either immediate or delayed access to the online DA which (i) explained the benefits and harms, (ii) included a values clarification exercise and a worksheet to support decision making. The primary outcome, knowledge of benefits and harms of screening, and secondary outcomes, informed choice (composite of knowledge, values and intention), anxiety and acceptability of the DA were measured using online questionnaires. RESULTS Women in the intervention group were more knowledgeable (mean score out of 10, 7.35 vs 6.27, p<0.001) and were more likely to have made a decision (82% vs 61% p<0.001). Of those who made a decision, women in the intervention group were less likely to start screening now (52% vs 65% p=0.05). There was no significant difference in the proportion of women who made an informed choice (71% intervention group vs 64% control group, p=0.24). The DA was helpful, balanced and clear, and did not make women anxious. CONCLUSIONS The DA increased knowledge and reduced indecision, without increasing feelings of anxiety. PRACTICE IMPLICATIONS This decision aid is easy to access online and could be an inexpensive way of supporting women aged 40 who are considering whether to start screening now, or wait until they are 50. The results of this study demonstrate the potential of DAs to help inform women about both the benefits and risks of screening at this age and to support women and clinicians in this decision making process.

Use of decision aids to support informed choices about screening

Decisions about screening can be more complex than those about treatment. Well designed decision aids could help patients understand the risks as well as the benefits

Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results

Objective  To determine womens preferences for and reported experience with medical test decision‐making.

Beliefs and beyond: what can we learn from qualitative studies of lay people’s understandings of cancer risk?

Background  Clinicians and public health professionals are centrally concerned with mediating risk. However, people often resist the risk‐related information that is communicated to them by experts, or have their own models of risk that conflict with expert views. Quantitative studies have clearly demonstrated the importance of health beliefs and various cognitive and emotional processes in shaping risk perception. More recently, a growing body of qualitative research has emerged, exploring lay conceptualizations, experiences and constructions of cancer risk. To date, this literature has not been synthesized.

Women's preferences for and views on decision-making for diagnostic tests.

It is unclear whether the Control Preferences Scale (CPS) provides a suitable framework for eliciting womens preferences for involvement in decision-making about diagnostic tests. The aims of this study were to assess the appropriateness of the role label approach for eliciting preferences for decision-making about diagnostic tests and to elicit womens preferences for, and views about, decision-making for diagnostic tests. In-depth, face-to-face, semi-structured interviews were conducted with 37 women who had previously participated in a population-based telephone survey. Analysis of the interview transcripts revealed that qualitative questions may be a more sensitive methodology for eliciting preferences than the role label approach as exemplified by the CPS. The analysis identified a number of issues associated with decision-making for diagnostic tests, including defining what a decision is, the rationale for the preference and factors that influence the preferred role such as the perceived seriousness of the test and potential outcomes. The role label approach used to elicit preferences for involvement in decision-making may be too simplistic. It may not fully capture the complexity of womens thoughts about test decision-making, including how they define a decision and what factors affect their preference.

Writing social determinants into and out of cancer control: An assessment of policy practice

A large literature concurs that social determinants of health (SDH) are demonstrable, important, and insufficiently attended to in policy and practice. A resulting priority for research should be to determine how the social determinants of health can best be addressed. In this paper we support the more effective transfer of social determinants research into policy by: (1) describing a qualitative analysis of thirty-two cancer control policy documents from six English-speaking OECD countries and two transnational organizations, demonstrating great variability in the treatment of social determinants in these policies; (2) critiquing these various policy practices in relation to their likely impact on social determinants of health; and (3) advancing a tool that policy writers can use to assess the way in which social determinants of health have been addressed in their work. In the sample of policy documents, the distinction between structural and intermediate determinants, population-based and targeted interventions, and their respective relationships to equity were not always clear. The authors identified four approaches to social determinants (acknowledging SDH, auditing SDH, stating aims regarding SDH and setting out actions on SDH), and five ways of writing about the relationship between social determinants and cancer risk. These five discourses implied, respectively: that group membership was intrinsically risky; that not enough was known about SDH; that risk arose from choices made by individuals; that groups were constrained by circumstance; or that structural change was necessary. Socio-cultural factors were generally presented negatively, though New Zealand policies modeled a possible alternative. Based on their empirical work, the authors propose a matrix and a set of questions to guide the development and assessment of health policy.

Consumer information materials for diagnostic breast tests: women's views on information and their understanding of test results.

Objective  To explore womens views on diagnostic breast test information and elicit their preferences for this information.

Writing the risk of cancer: Cancer risk in public policy

In this paper we examine how cancer risk is written in cancer policy documents from the English speaking OECD nations. We offer an audit of the multiple ways in which cancer risk is conceptualised and presented in health policy and professional contexts with the long term aim of comparing this with lay conceptualisations. Our study sampled cancer policy documents produced by six nations, the World Health Organization and the International Union for Cancer Control since 2000 and analysed them iteratively through questions and codes. Whilst the documents contained a comprehensive range of concepts and locations for cancer risk, our analysis found two predominant representations: firstly, well established metaphors that depict cancer as uniformly dreadful and life threatening; and secondly, through a concentration on five behavioural risk factors (tobacco smoking, drinking alcohol, inadequate nutrition, sun exposure and physical inactivity) and one bodily state (overweight). We discuss the implications of this dual focus and of other tensions within ideas about cancer risk that we identified for risk communication.

The impact of different criteria for selecting information to be provided to women undergoing diagnostic breast tests.

OBJECTIVE To determine if the content of written information for women undergoing diagnostic breast tests would change depending on the criteria used to decide what information should be included. METHODS Questionnaire study eliciting the views of advocates, breast physicians, breast surgeons, general practitioners, people with an interest in ethics, and women who had undergone breast tests on information that should be provided to women undergoing diagnostic breast tests. Different criteria were used to determine what information should be included in the written information. RESULTS Advocates, breast physicians, breast surgeons, general practitioners, people with an interest in ethics, and women who had undergone breast tests held significantly different views about the importance of specific information items for women undergoing tests. Different methods of resolving these differences in views lead to the inclusion of different information in patient information material. CONCLUSION This study highlights the practical necessity for guidelines for developing written information to include details about how to resolve differences in opinions about what information should be included in patient material. PRACTICE IMPLICATIONS Further research is needed to determine the most appropriate way to decide the content of written information. In the meantime, developers of written patient information need to be cognizant of the effects of their decisions on the content of patient information.