Discussions of Potential Mammography Benefits and Harms among Patients with Limited Health Literacy and Providers: "Oh, There are Harms?"

Published on Jan 17, 2021in Journal of Health Communication
· DOI :10.1080/10810730.2020.1845256
Ariel Maschke3
Estimated H-index: 3
(BU: Boston University),
Michael K. Paasche-Orlow60
Estimated H-index: 60
(BU: Boston University)
+ 3 AuthorsChristine M. Gunn9
Estimated H-index: 9
(BU: Boston University)
Starting breast cancer screening at age 40 versus 50 may increase potential harms frequency with a small mortality benefit. Younger women's screening decisions, therefore, may be complex. Shared decision-making (SDM) is recommended for women under 50 and may support women under 55 for whom guidelines vary. How women with limited health literacy (LHL) approach breast cancer screening decision-making is less understood, and most SDM tools are not designed with their input. This phenomenological study sought to characterize mammography counseling experiences among women with LHL and primary care providers (PCPs). Women ages 40-54 with LHL who had no history of breast cancer or mammogram within 9 months were approached before a primary care visit at a safety-net hospital. PCPs at this site were invited to participate. Qualitative interviews explored mammography counseling experiences. Patients also reviewed sample information materials. A constant comparison technique generated four themes salient to 25 patients and 20 PCPs: addressing family history versus comprehensive risk assessment; potential mammography harms discussions; information delivery preferences; and integrating pre-visit information tools. Findings suggest that current counseling techniques may not be responsive to patient-identified needs. Opportunities exist to improve how mammography information is shared and increase accessibility across the health literacy spectrum.
#1Christine M. Gunn (BU: Boston University)H-Index: 2
#2Ariel Maschke (BU: Boston University)H-Index: 3
Last. Tracy A. Battaglia (BU: Boston University)H-Index: 22
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Limited health literacy is a driver of cancer disparities and associated with less participation in medical decisions. Mammography screening decisions are an exemplar of where health literacy may impact decision-making and outcomes. To describe informational needs and shared decision-making (SDM) experiences among women ages 40–54 who have limited health literacy and primary care providers (PCPs). Qualitative, in-depth interviews explored experiences with mammography counseling and SDM. Women ag...
2 CitationsSource
#1Weijia Shi (UMN: University of Minnesota)H-Index: 1
#2Rebekah H. Nagler (UMN: University of Minnesota)H-Index: 18
Last. Sarah E. Gollust (UMN: University of Minnesota)H-Index: 39
view all 4 authors...
ABSTRACTIn recent years, there has been a shift toward promoting informed decision making for mammography screening for average-risk women in their 40s. Professional organizations such as the Ameri...
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Abstract Background Discussions about whether to continue breast cancer screening in older women are complex, particularly for African American women. Decision aids may be helpful in guiding these conversations; however, little is known about the feasibility and acceptability of using breast cancer decision aids in older African American women. This study explored African American women's knowledge of breast cancer screening guidelines in older adults, prior conversations with providers regardin...
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#1Kenneth D. Croes (UW: University of Wisconsin-Madison)H-Index: 4
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Last. Elizabeth S. Burnside (UW: University of Wisconsin-Madison)H-Index: 16
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The United States Preventive Services Task Force recommends individualized breast cancer screening for average-risk women before age 50, advised by risk assessment and shared decision-making (SDM). However, the foundational principles of this recommendation that would inform decision support tools for patients and primary care physicians at the point of care have not been codified. Determining the core elements of SDM for breast cancer screening as valued by patients and primary care providers (...
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#1Jordonna Brown (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 2
#2Chloe Soukas (RU: Rutgers University)H-Index: 1
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#1Mónica Pérez Jolles (SC: University of Southern California)H-Index: 8
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Abstract Objectives This systematic review of contemporary literature sought to better understand racial and ethnic minority patients’ shared decision-making (SDM) preferences, challenges and facilitators. Methods Data sources were PubMed, CINAHL, Embase, Google Scholar, PsycINFO, Sociological Abstracts, and Web of Science databases for publications between 2011 and 2016. Publications were included if they studied SDM during the clinical encounter for minority adults in clinical care in the Unit...
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#1Lori L. DuBenske (UW: University of Wisconsin-Madison)H-Index: 16
#2Sarina Schrager (UW: University of Wisconsin-Madison)H-Index: 13
Last. Elizabeth S. Burnside (UW: University of Wisconsin-Madison)H-Index: 19
view all 7 authors...
Background New guidelines recommend shared decision-making (SDM) for women and their clinician in consideration of breast cancer screening, particularly for women ages 35–50 where guidelines for routine mammography are controversial. A number of models offer general guidelines for SDM across clinical practice, yet they do not offer specific guidance about conducting SDM in mammography. We conducted a scoping review of the literature to identify the key elements of breast cancer screening SDM and...
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#1Jayoung Han (Fairleigh Dickinson University)H-Index: 3
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Last. Dongwoo KoH-Index: 1
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We examined the effect of shared decision-making (SDM) on women’s adherence to breast and cervical cancer screenings and estimated the prevalence and adherence rate of screenings. The study used a descriptive cross-sectional design using the 2017 Health Information National Trends Survey (HINTS) data collected by the National Cancer Institute. Adherence was defined based on the guidelines from the American Cancer Society and the composite measure of shared decision-making was constructed using t...
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#2Kate M. Fennell (Flinders University)H-Index: 10
Last. Patricia M. Livingston (Deakin University)H-Index: 33
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Informal caregivers provide extended support to people with cancer but they receive little support from the health care system to assist them in their caring role. The aim of this single-blind, multi-centre, randomised controlled trial was to test the efficacy of a telephone outcall program to reduce caregiver burden and unmet needs, and improve psychological well-being among cancer caregivers, as well as evaluating the potential impact on patient outcomes. Cancer patient/caregiver dyads (N = 21...
18 CitationsSource
#1Sophia Siedlikowski (McGill University)H-Index: 2
#2Carolyn Ells (McGill University)H-Index: 16
Last. Gillian Bartlett (McGill University)H-Index: 26
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Context A decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncerta...
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