Messaging Strategies to Reduce Breast Cancer Over-Screening in Older Women

项目总结 这项行政补充提案侧重于围绕说服的使用进行的生物伦理学研究 健康沟通，特别是在减少乳腺癌过度筛查的背景下。乳房X光摄影 筛查可能会降低乳腺癌的死亡率和发病率，但潜在的好处往往被推迟 许多年来，虽然可能在短期内发生重大损害。常规筛查的危害超过了 在预期寿命有限的老年妇女中受益，但其中许多妇女仍在接受筛查， 强调需要采取干预措施，促进适当的停止筛查和减少过度筛查 在年长的女性身上。我们的项目(R01AG066741)正在研究消息传递干预的新用途，通过 临床医生-患者沟通和其他来源(家人、朋友和媒体)，以减少过度筛查。 许多健康沟通策略，如建立可信度，利用情感诉求， 和使用故事，本质上是有说服力的，并用来改变行为。父R01项目计划 使用这种有说服力的策略测试各种信息，但潜在的伦理影响尚不清楚。 一种观点认为，使用劝说可能是操纵性的，并威胁到患者的自主权，而另一些观点则认为 认为有必要引导患者选择促进福利(慈善)和最小化的选择 危害(非恶意)。目前还不清楚在利/害平衡范围内，这可能是什么程度 从告知转变为说服在伦理上是可以接受的，或者什么形式的说服在 减少过度筛查的背景。 此补充项目旨在建立在父项目的基础上，以解决使用 劝说减少乳腺癌过度筛查。首先，我们将考察老年女性的道德信仰和 关于这一主题的价值。我们建议对30名老年妇女进行定性的深度访谈(目标1)和 对3000名老年妇女进行量化调查(目标2)，后者利用具有全国代表性的在线 已计划作为父项目的一部分的调查。然后，我们将召集一个专家组， 生物伦理学家、临床医生、健康传播和癌症筛查研究人员。专家小组将审议并 反思AIMS 1和AIMS 2的经验结果，现有关于乳腺癌筛查和 消息传递，以及患者自主和仁慈/非恶意的相互竞争的伦理原则，以 就如何在取消过度筛查中使用劝说提出建议(目标3)。 拟议的项目将建立在现有的R01和1)确定不仅有效的信息 减少过度筛查，但在伦理上也是可以接受的，以及2)制定一个道德框架，以指导 下一步消息传递干预。更广泛地说，结果将有助于解决适当和有效的使用 在取消实施的情况下，在临床护理和公共卫生方面使用健康传播工具。

PROJECT SUMMARY This administrative supplement proposal focuses on bioethics research around the use of persuasion in health communication, specifically in the context of reducing breast cancer over-screening. Mammography screening may decrease breast cancer mortality and morbidity but the potential benefits are often delayed for many years while significant harms can occur in the short term. The harms of routine screening outweigh the benefits among older women with limited life expectancies, but many of these women continue to be screened, highlighting the need for interventions to promote appropriate screening cessation and reduce over-screening in older women. Our project (R01AG066741) is studying the novel use of messaging interventions, via clinician-patient communication and other sources (family, friends, and the media), to reduce over-screening. Numerous health communication strategies, such as establishing credibility, using emotional appeals, and using stories, are inherently persuasive and used to change behaviors. The parent R01 project plans to test various messages employing such persuasive strategies but the potential ethical implications are unclear. One perspective asserts that using persuasion may be manipulative and threat patient autonomy while others argue that it is essential to guide patients towards options that promote benefits (beneficence) and minimize harms (non-maleficence). It is not clear at what point across the benefits/harms balance spectrum it may be ethically acceptable to shift from informing to persuading or what forms of persuasion are acceptable in the context of reducing over-screening. This supplement project aims to build upon the parent project to address ethical issues around using persuasion to reduce breast cancer over-screening. First, we will examine older women’s moral beliefs and values on this topic. We propose both qualitative in-depth interviews of 30 older women (Aim 1) and quantitative surveys of 3000 older women (Aim 2), where the latter leverages a nationally representative online survey that is already planned as part of the parent project. Then, we will convene an expert panel of bioethicists, clinicians, health communication and cancer screening researchers. The panel will deliberate and reflect upon the empirical results from Aims 1 and 2, existing literature on breast cancer screening and messaging, and the competing ethical principles of patient autonomy and beneficence/non-maleficence, to make recommendations on how to use persuasion in de-implementing over-screening (Aim 3). The proposed project will build on the existing R01 and 1) identify messages that are not only effective for reducing over-screening but are also ethically acceptable, and 2) develop an ethical framework to guide the next-step messaging intervention. More broadly, the results will help address the appropriate and effective use of health communication tools in both clinical care and public health in the context of de-implementation.