Understanding affective processing of scientific evidence to promote informed choice for breast cancer screening

项目概要/摘要 在正确的癌症风险水平下为正确的患者进行癌症筛查可以挽救生命，但在过去的几年里， 多年来，许多专家组已经降低了乳房X光检查的建议，因为 对某些人群造成净伤害的证据。乳房X光检查筛查的新建议强调了 根据年龄、风险和合并症量身定制的方法，旨在最大限度地减少伤害， 可以受益最多。例如，根据美国预防服务工作组， 指南，40-49岁的女性应该与他们的医生交谈，并就是否 开始筛选重点的变化，从大力推动每年为所有妇女进行乳房X光检查， 40在这个年龄组促进知情选择构成了医学逆转，在这个意义上，这一新的 与过去的信息和人们的期望有很大的不同。此外，关于 知情选择可能会引起一些妇女的负面反应。许多女性在被告知 过度诊断和过度治疗，这是筛查的重大危害。基于风险的概念 筛查--也就是根据女性的客观癌症风险制定筛查计划--可能会引起怀疑 医疗保健配给。其结果是出现了一种微妙的局面，需要将证据传达给 妇女，使她们能够作出知情的选择，但也需要以一种保持信誉的方式这样做， 尽管这种健康信息的逆转。在本研究中，我们重点关注四种类型的关注反应 女性对乳房X光检查证据的反应：反应（即感知操纵或 影响，例如“这是试图配给医疗保健”）、自我豁免（例如，“这不适用于我”），不信 (e.g.,“你不能相信所有的研究无论如何”），和来源减损（例如，“我不相信这个来源”）， 我们简称为红色这项研究将确定这些反应的情感和认知预测因素， 确定这些反应对筛选偏好和共同决策的影响。目标1 我们将对40-49岁的女性进行一项具有全国代表性的调查， REDS反应的预测因子和筛查意图的后果。在目标2中，我们将进行 纵向调查，并确定妇女对证据的态度如何预测共同决策 在即将到来的初级保健预约中进行乳房X光检查，我们还将研究这些态度 随着时间的推移而变化，并受到妇女更广泛的社会环境的影响。在目标3中，我们将 访谈和焦点小组，以确定更有效地沟通筛查的策略， 消极的REDS反应，促进积极的反应，如授权和共同决策的愿望 制作。我们将修改现有的乳房X光检查决策辅助工具，以纳入这些改进，然后 对这些改进进行随机试点测试，以提供减少REDS的初步证据 提高女性对乳房X光检查的积极反应。

Project Summary/Abstract Cancer screening for the right patients at the right level of cancer risk can save lives, but over the last several years many expert groups have de-intensified mammography screening recommendations because of evidence of net harm for certain populations. Newer recommendations for mammography screening highlight a tailored approach based on age and risk and comorbidities, aiming to minimize harms and reach women who could benefit the most. For example, according to the United States Preventive Services Task Force guidelines, women age 40-49 should talk with their doctor and make an informed choice about whether to initiate screening. The change in emphasis from strongly promoting annual mammograms for all women over 40 to promoting informed choice in this age group constitutes a medical reversal, in the sense that this new message is very different from past messages and people’s expectations. Moreover, the recommendation for informed choice can elicit negative reactions in some women. Many women express disbelief when told about overdiagnosis and overtreatment, which are significant harms of screening. The notion of risk-based screening—that is, creating a screening plan tailored to a woman’s objective cancer risk—can raise suspicions of healthcare rationing. The result is a delicate situation in which there is need to convey the evidence to women so they can make an informed choice, but also a need to do it in a way that maintains credibility and trust despite this health message reversal. In this research we focus on four types of concerning responses that women may express in reaction to mammography evidence: Reactance (i.e. perceived manipulation or influence, e.g. “this is trying to ration healthcare”), self-Exemption (e.g., “this doesn’t apply to me”), Disbelief (e.g., “you can’t believe all the research anyway”), and Source derogation (e.g., “I don’t trust this source”), which we shorten to REDS. This research will identify affective and cognitive predictors of these reactions, and identify the consequences of these reactions for screening preferences and shared decision-making. In Aim 1 we will conduct a nationally representative survey of women age 40-49 and test affective and cognitive predictors of REDS reactions and consequences for screening intentions. In Aim 2 we will conduct a longitudinal survey and identify how women’s attitudes toward the evidence predicts shared decision making for mammography in an upcoming primary care appointment, and we will also examine how these attitudes change over time and are influence by women’s broader social environment. In Aim 3, we will conduct interviews and focus groups to identify strategies for communicating more effectively about screening, to avoid negative REDS responses, and promote positive responses like empowerment and desire for shared decision making. We will modify an existing mammography decision aid to incorporate these improvements, and then conduct randomized pilot tests of these improvements to provide preliminary evidence that they reduce REDS and improve women’s positive responses to mammography evidence.