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

减少老年女性乳腺癌过度筛查的信息传递策略

• 批准号: 10592067
• 负责人: Nancy Schoenborn
• 金额: $ 16.36万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592067
• 关键词: Address; Administrative Supplement; Age; Area; Attitude; Behavioral; Belief; Beneficence; Bioethics; Bioethics Consultants; Breast Cancer Detection; COVID-19 pandemic; Caring; Case Study; Clinical Treatment; Communication Tools; Critiques; Deimplementation; Diagnosis; Elderly; Emotional; Equilibrium; Ethical Issues; Ethics; Family; Foundations; Friends; Future; Guidelines; Harm Reduction; Health Professional; Healthcare; Individual; Intervention; Interview; Knowledge; Life; Life Expectancy; Literature; Malignant Neoplasms; Mammographic screening; Misinformation; Morals; Morbidity - disease rate; Nonmaleficence; Outcome; Parents; Patients; Persuasive Communication; Policies; Public Health; Reaction; Recommendation; Research; Research Personnel; Screening for cancer; Source; Surveys; Techniques; Testing; Woman; behavior change; clinical care; health communication; implementation efforts; malignant breast neoplasm; mortality; novel; older patient; older women; overtreatment; parent grant; parent project; patient-clinician communication; routine screening; screening; smoking cessation; theories; tool; uptake

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.

项目摘要 这项行政补充提案着重于围绕说服力使用的生物伦理学研究 健康沟通，特别是在减少乳腺癌过度筛查的情况下。乳房X线摄影 筛查可能会降低乳腺癌的死亡率和发病率，但潜在的好处通常会延迟 多年来，短期内可能会造成重大危害。常规筛查的危害超过 预期寿命有限的老年妇女的好处，但其中许多妇女继续被筛查， 强调需要采取干预措施以促进适当的筛查并减少过度筛查 在老年妇女中。我们的项目（R01AG066741）通过 临床患者的沟通和其他来源（家人，朋友和媒体），以减少过度筛查。 许多健康沟通策略，例如使用情感表现建立信誉， 并且使用故事是有说服力的，并用于改变行为。父母R01项目计划 测试采用这种有说服力的策略的各种消息，但潜在的道德含义尚不清楚。 一种观点断言，使用说服力可能是操纵性和威胁患者的自主权，而其他人的自主权 认为指导患者采取促进福利（福利）并最小化的选择是至关重要的 危害（非遗憾）。目前尚不清楚可能是在什么点上的利益/危害平衡频谱 从道德上可以接受，可以从告知转变为说服或哪种形式的说服力可以接受 减少过度筛查的背景。 这个补充项目旨在建立父母项目，以解决有关使用的道德问题 说服力减少乳腺癌过度筛查。首先，我们将研究老年妇女的道德信念，并 关于这个主题的价值。我们提出了30名老年妇女（AIM 1）和 对3000名老年妇女（AIM 2）的定量调查，后者利用全国代表性的在线 作为父母项目的一部分已计划的调查。然后，我们将召集一个专家小组 生物伦理学家，临床医生，健康传播和癌症筛查研究人员。小组将考虑并 反思目标1和2的经验结果，《现有有关乳腺癌筛查的文献》和 消息传递，以及患者自主权和福利/非遗憾的相互竞争的道德原则， 就如何使用说服力进行超筛查（AIM 3）提出建议。 拟议的项目将基于现有的R01和1）确定不仅有效的消息 为了减少过度筛查但在道德上也可以接受，以及2）建立一个道德框架来指导 下一步消息干预。更广泛地，结果将有助于解决适当有效的用途 在临床护理和公共卫生中的健康交流工具的范围内。