Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions
Department of Family Medicine and Community Health; Meyers Primary Care Institute; Department of Quantitative Health Sciences
Family Medicine | Health Services Research | Neoplasms | Primary Care | Public Health Education and Promotion
PURPOSE: We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODS: We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict. RESULTS: Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = <.001) for men and -0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure. CONCLUSIONS: Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.
cancer screening, clinical decision making, early detection of cancer, mammography, persuasive interventions, prostate cancer
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Citation: Ann Fam Med. 2017 Jan;15(1):48-55. doi: 10.1370/afm.1996. Epub 2017 Jan 6. Link to article on publisher's site
Annals of family medicine
Saver, Barry G.; Mazor, Kathleen M.; Luckmann, Roger; Cutrona, Sarah L.; Hayes, Marcela; Gorodetsky, Tatyana; Esparza, Nancy; and Bacigalupe, Gonzalo, "Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions" (2017). University of Massachusetts Medical School Faculty Publications. 1280.