Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial
Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial
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DOI：
10.1016/s0140-6736(15)60123-4
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发表时间：
2015-04-25
期刊：
影响因子：
168.9
通讯作者：
McCaffery, Kirsten
中科院分区：
文献类型：
--
作者：
Hersch, Jolyn;Barratt, Alexandra;McCaffery, Kirsten
背景乳腺X线筛查可以降低乳腺癌死亡率。然而，大多数妇女没有意识到，通过筛查也可以发现无关紧要的疾病，导致过度诊断和过度治疗。我们的目的是调查是否包括在决策援助的乳腺癌过度检测的信息将有助于妇女年龄在50岁左右，使知情的选择乳房screening.Methods我们做了一个以社区为基础的，平行组，随机对照试验在澳大利亚新南威尔士州，使用一个随机队列的妇女年龄在48-50岁。这项研究的招募是通过电话进行的;如果妇女在过去的2年里没有做过乳房X光检查，并且没有乳腺癌的个人或强烈的家族史，那么她们就有资格参加这项研究。通过计算机程序，我们将879名参与者随机分配到干预决策辅助工具（包括关于过度检测，乳腺癌死亡率降低和假阳性的循证解释和定量信息）或控制决策辅助工具（包括关于乳腺癌死亡率降低和假阳性的信息）。参与者和访谈者对分组不知情。主要结果是知情选择（定义为足够的知识和态度和筛查意图之间的一致性），我们通过电话采访随机分配后约3周进行评估。在所有完成相关随访访谈问题的妇女中分析主要结局。该试验在澳大利亚新西兰临床试验注册处注册，编号ACTRN 12613001035718。结果在2014年1月至2014年7月期间，440名妇女被分配到干预组，439名妇女被分配到对照组。干预组的21名妇女和20名对照组妇女失访;另外10名分配到干预组的妇女和11名对照组妇女没有回答所有关于态度的问题。因此，对干预组的409名妇女和408名对照妇女进行了主要结局分析。干预组409名妇女中有99名（24%）做出了知情选择，而对照组408名妇女中有63名（15%）做出了知情选择（差异9%，95%CI 3-14; p= 0.0017）。与对照组相比，干预组中更多的妇女达到了充分的总体知识的阈值（122/419 [29%] vs 71/419 [17%];差异12%，95%CI 6-18; p
Background Mammography screening can reduce breast cancer mortality. However, most women are unaware that inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment. We aimed to investigate whether including information about overdetection of breast cancer in a decision aid would help women aged around 50 years to make an informed choice about breast screening.Methods We did a community-based, parallel-group, randomised controlled trial in New South Wales, Australia, using a random cohort of women aged 48-50 years. Recruitment to the study was done by telephone; women were eligible if they had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer. With a computer program, we randomly assigned 879 participants to either the intervention decision aid (comprising evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false positives) or a control decision aid (including information on breast cancer mortality reduction and false positives). Participants and interviewers were masked to group assignment. The primary outcome was informed choice (defined as adequate knowledge and consistency between attitudes and screening intentions), which we assessed by telephone interview about 3 weeks after random allocation. The primary outcome was analysed in all women who completed the relevant follow-up interview questions fully. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001035718.Findings Between January, 2014, and July, 2014, 440 women were allocated to the intervention group and 439 were assigned to the control group. 21 women in the intervention group and 20 controls were lost to follow-up; a further ten women assigned to the intervention and 11 controls did not answer all questions on attitudes. Therefore, 409 women in the intervention group and 408 controls were analysed for the primary outcome. 99 (24%) of 409 women in the intervention group made an informed choice compared with 63 (15%) of 408 in the control group (difference 9%, 95% CI 3-14; p= 0.0017). Compared with controls, more women in the intervention group met the threshold for adequate overall knowledge (122/419 [29%] vs 71/419 [17%]; difference 12%, 95% CI 6-18; p