Testing a Conversation Aid on Mammography Screening for Primary Care Clinicians and Women 75 and Older

Status: closed to accrual

This study tests the effect of a web-based conversation aid on shared decision making (SDM) around mammography screening between primary care clinicians (PCP) and women aged 75 and older and their family. Breast cancer is the most common life-threatening cancer in women and the risk increases with age. Mammography screening is associated with a reduction in breast cancer death in women under 75 years old and effectiveness in those over 75 is uncertain. Guidelines recommend that PCPs engage women 75 and older in shared decision making that considers breast cancer risk, life expectancy, and values and preferences. Despite this, over 50% of women 75 and older report screening, including women with less than 10 year life expectancy and little chance of benefit. A major driver of screening in older women is their PCP's recommendations. PCP's find SDM around mammography challenging. A web-based conversation aid may provide individualized benefits and harms of mammography screening and allow PCP's to provide guidance based on the informational needs, literacy and decision making preferences of women 75 and older and their family.

Inclusion Criteria

PATIENTS: English-speaking women aged 75-89 years seen by an attending-level (non-resident) seen at the recruitment practices who have the ability and willingness to provide verbal consent
FAMILY MEMBERS: Family member of patient that has agreed to participate in the study
FAMILY MEMBERS: Age > 18
FAMILY MEMBERS: English speaking
FAMILY MEMBERS: Ability and willingness to provide verbal consent
PRIMARY CARE PROVIDER: Non-resident physician, nurse practitioner, or physician assistant
PRIMARY CARE PROVIDER: > 18 years old
PRIMARY CARE PROVIDER: English speaking
PRIMARY CARE PROVIDER: Cares for a panel of patients that includes women >= 75 years at one of the recruitment practices

Exclusion Criteria

PATIENTS: Last mammogram < 6 or > 36 months (so that participants may be contemplative of their next mammogram)
PATIENTS: History of dementia
PATIENTS: Incapacity for informed consent
PATIENTS: History of invasive or non-invasive breast cancer
PATIENTS: Last mammogram was abnormal
PATIENTS: Non-English speaking
PATIENTS: Already chose to stop being screened (documented in medical records or scores of 1-3 [do not intend to be screened] on a validate 15 point intentions to be screened scale.)
PATIENTS: PCP unwilling to have patient participate
PATIENTS: In hospice
PATIENTS: PCP not willing to participate
PATIENTS: Psychiatric illness situations that would limit compliance with study requirements
FAMILY MEMBERS: Age < 18
FAMILY MEMBERS: Non-English speaking
FAMILY MEMBERS: Psychiatric illness situations that would limit compliance with study requirements
PRIMARY CARE PROVIDER: Ability and willingness to provide verbal consent
PRIMARY CARE PROVIDER: Resident physician
PRIMARY CARE PROVIDER: Psychiatric illness situations that would limit compliance with study requirements

PRIMARY OBJECTIVE:

I. To conduct a pilot pretest-posttest trial to learn if providing a web-based conversation aid (CA) on mammography screening to 65 PCPs (primary care physicians/nurse practitioners) facilitates shared decision making (SDM) and with 130 of their patients (2-3 per PCP) aged 75-89 years and 25 involved family members.

OUTLINE: Participants are assigned to 1 of 2 groups.

GROUP I: PCPs receive access to the web-based CA, attend clinic visit with patient and family member and complete a questionnaire at entrance to and at the end of study.

GROUP II: Patients and family members attend clinic visit with PCP and complete questionnaires before and up to 2 weeks after clinic visit. Additionally, patients' medical records are reviewed on study.

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Testing a Conversation Aid on Mammography Screening for Primary Care Clinicians and Women 75 and Older

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