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

项目摘要/摘要 对癌症风险水平合适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，许多专家小组已经取消了乳房X光检查的建议，因为 对某些人群造成净伤害的证据。较新的乳房X光检查建议突出了 基于年龄、风险和合并症的量身定做的方法，旨在将伤害降至最低，并接触到 可能受益最大。例如，根据美国预防服务工作组的说法 指导方针，40-49岁的女性应该与她们的医生商量，并在知情的情况下选择是否 启动筛查。重点从大力推广所有女性的年度乳房X光检查转变 40在这个年龄段促进知情选择构成了医学上的逆转，从这个意义上说，这一新的 信息与过去的信息和人们的期望有很大的不同。此外，关于 知情的选择可能会在一些女性中引发负面反应。当被告知时，许多女性表示难以置信 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--即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。结果是出现了一种微妙的情况，在这种情况下，需要将证据传达给 女性，这样她们才能做出明智的选择，但也需要以一种保持可信度和 尽管健康信息发生了逆转，但还是要信任。在本研究中，我们重点研究了四种类型的关注性反应 女性对乳房X光检查证据可能表现出的反应：抵抗力(即感知到的操纵或 影响力，例如“这是在尝试定量配给医疗保健”)，自我豁免(例如，“这不适用于我”)，不相信 (例如，“无论如何你都不能相信所有的研究”)，以及来源贬损(例如，“我不信任这个来源”)， 我们把它缩短为红色。这项研究将确定这些反应的情感和认知预测因素，并 确定这些反应对筛选偏好和共享决策的影响。在目标1中 我们将对40-49岁的女性进行一项具有全国代表性的调查，并测试情感和认知能力 红军反应的预测者和筛选意图的后果。在目标2中，我们将进行一项 纵向调查并确定女性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，我们还将检查这些态度如何 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，我们将进行 面谈和焦点小组以确定更有效地沟通筛查的策略，以避免 消极的红军反应，促进积极的反应，如赋权和共享决策的愿望 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，以提供初步证据表明它们可以降低红外线 并提高女性对乳房X光检查证据的积极反应。

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.