Data were presented in part at the Annual Meeting of the Society of General Internal Medicine in Vancouver, British Columbia, in May 2003.
Informed decision making before initiating screening mammography: does it occur and does it make a difference?
Article first published online: 24 NOV 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Volume 11, Issue 4, pages 366–375, December 2008
How to Cite
Nekhlyudov, L., Li, R. and Fletcher, S. W. (2008), Informed decision making before initiating screening mammography: does it occur and does it make a difference?. Health Expectations, 11: 366–375. doi: 10.1111/j.1369-7625.2008.00514.x
- Issue published online: 24 NOV 2008
- Article first published online: 24 NOV 2008
- Accepted for publication 16 April 2008
- breast cancer;
- decision making;
- screening mammography
Objective Informed decision making regarding screening mammography is recommended for women under age 50. To what extent it occurs in clinical settings is unclear.
Methods Using a mailed instrument, we surveyed women aged 40–44 prior to their first screening mammogram. All women were members of a large health maintenance organization and received care at a large medical practice in the Greater Boston area. The survey measured informed decision making, decisional conflict, satisfaction, and screening mammography knowledge and intentions to undergo screening.
Results Ninety-six women responded to the survey (response rate 47%). Overall, women reported limited informed decision making regarding screening mammography, both with respect to information exchange and involvement in the decision process. Less than half (47%) reported discussing the benefits of screening; 23% the uncertainties; and only 7% the harms. About 30% reported discussing the nature of the decision or clinical issue; and 29% reported their provider elicited their preferred role in the decision; 38% their preferences; and 24% their understanding of the information. Women who were uninformed had higher decisional conflict (2.37 vs. 1.83, P = 0.005) about screening mammography and were more likely to be dissatisfied with the information and involvement. Women’s screening mammography knowledge was limited in most areas; however being presented with information did not diminish their intentions to undergo screening.
Conclusion Informed decision making before initiating screening mammography is limited in this setting. There appears to be little indication that information about the benefits and harms decreases women’s intentions to undergo screening. Methods to communicate information to women before initiating screening mammography are needed.