Strengths and Weakness of Decision Aids for Women Regarding Mammographic Screening

Utilizing the International Patient Decision Aid Standards instrument, version 3 (IPDASi), researchers highlighted the strengths and weaknesses of existing decision aids for women with an average risk of breast cancer who are eligible for mammographic screening.

The review, published in Cancer, also provided a classification of the existing aids and analyzed the existing decision aids on various dimensions. 

“The results demonstrate a need to better address health literacy when creating future decision aids,” the authors wrote. “This review also demonstrates a lack of field testing for decision aids.”

The systematic review included articles published between January 1, 1997 and August 1, 2019 in the PubMed, Embase, Cochran, and PsycInfo databases. Moreover, the studies were reviewed independently by 2 reviewers. Any study which contained a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. 

Two double-blind reviewers evaluated the quality of the selected decision aids using the IPDASi, and 23 decision aids were extracted. Further, classification of decision aid quality using the IPDASi showed large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172).

The 3 best-rated dimensions were:

• Disclosure (maximum score, 8; mean score, 6.8), focusing on transparency 

• Information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details

• Probabilities (maximum score, 32; mean score, 25), focusing on the presentation of probabilities

The 3 lowest-rated dimensions were:

• Decision support technology evaluation (maximum score, 8; mean score 4.3), focusing on the effectiveness of the decision aid

• Development (maximum score, 24; mean score, 12.6), evaluating the development process

• Plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy

Overall, the results of the review only identified 3 high-quality decision aids for breast cancer screening.

This review confirmed that few decision aids for women with an average risk of breast cancer who are eligible for mammography screening address health literacy concerns. Given that individuals with lower literacy and lower educational levels have greater risk of advanced cancer, the researchers indicated that this finding requires specific attention in the future. 

“Based on this review, further research should focus on developing online decision aids rather than paper-based tools,” the authors wrote. “Online decision aids were well rated on almost all dimensions, including the information, probabilities, values, decision guidance, disclosure, and test dimensions, and 2 dimensions were particularly relevant when focusing on the shared decision-making process, namely, the values and decision guidance dimensions.”

The researchers also noted that online decision aids would support a deliberative decision-making process, despite the lack of an actual clinical encounter with a practitioner. Additionally, they would allow patients to provide personal information, such as age, risk factors, preferences, etc., more easily, and allow for other advantages, such as interactive learning videos and the possibility of making decisions step by step. 

Regardless of the platform though, the researchers indicated that the use of a high-quality decision aids should favor the implementation of shared decision making for women with an average risk of breast cancer who are eligible for mammographic screening. 

“In the future, the reporting of field testing for any new decision aid should be mandatory,” the authors wrote. “A general recommendation might be that future authors seeking to publish new decision aids – for women with an average risk or others – should already have evaluated the tool through an analysis using IPDASi, as performed in this review.”

Reference:

Hild S, Johanet M, Valenza A, Thabaud M, Laforest F, Ferrat E, Rat C. Quality of Decision Aids Developed for Women at Average Risk of Breast Cancer Eligible for Mammographic Screening: Systematic Review and Assessment According to the International Patient Decision Aid Standards Instrument. Cancer. doi:10.1002/cncr.32858.