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

项目摘要 乳房X线摄影筛查可能会降低乳腺癌的死亡率和发病率，但其潜在的益处 通常会延迟多年，而重大危害可能在短期内发生。虽然乳腺癌 发病率随着年龄的增长而增加，老年妇女也面临着更高的筛查相关伤害和负担的风险 与年轻女性相比。常规筛查的危害超过了老年妇女的好处， 预期寿命有限，但其中许多妇女继续接受筛查，这突出表明需要 采取干预措施，促进适当停止筛查，以减少老年妇女的过度筛查。 我们之前的研究表明，老年人愿意在建议时停止常规癌症筛查 他们的临床医生。我们还发现，临床医生越来越愿意建议老年患者放弃 在弊大于利时进行筛查。然而，患者有时会收到自相矛盾的信息， 他们的家人、朋友或新闻媒体削弱了临床医生建议的影响， 有助于过度筛选。 这个项目的目的是研究如何从临床医生，家人和朋友，以及媒体，分别 共同影响老年妇女的乳腺癌筛查意向， 最有效地减少乳腺癌过度筛查的信息策略。我们力求做到这一点 通过三个目标。我们将首先确定哪些信息旨在减少乳腺癌过度筛查 在一项对600名老年妇女进行的全国在线调查中，这些数据被认为是最可信的（目标1）。然后，我们将进行一次 两波在线调查实验与3,000名老年妇女，以检查的综合影响， 来自不同来源（包括临床医生、社会关系和新闻媒体）的相互矛盾的信息， 乳腺癌筛查的信念，态度和意图随着时间的推移（目标2）。最后，我们将聚焦 与多专业持份者组成小组，制定策略，传递目标2的信息， 有效减少过度筛选的意图（目标3）。 拟议的项目将确定有效的信息战略，以促进适当的筛查 停止和减少对老年妇女乳腺癌的过度筛查，并让利益攸关方参与， 信息传播。结果将直接通知沟通干预作为下一步，以减少 老年妇女中乳腺癌的过度筛查。

PROJECT SUMMARY 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. While breast cancer incidence increases with age, older women are also at higher risks for screening-related harms and burdens compared to younger women. 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 in order to reduce over-screening in older women. Our prior research suggests that older adults are willing to stop routine cancer screening when recommended by their clinicians. We also found that clinicians are increasingly willing to recommend that older patients forgo screening when harms outweigh the benefits. However, patients at times receive contradictory messages from their family, friends, or the news media which weaken the impact of the clinicians' recommendations and contribute to over-screening. This project aims to examine how messages from clinicians, family and friends, and media, separately and together, impact breast cancer screening intentions among older women, with the goal of identifying messaging strategies that most effectively reduce breast cancer over-screening. We seek to accomplish this goal through 3 aims. We will first establish which messages intended to reduce breast cancer over-screening are considered most credible in a national online survey of 600 older women (Aim 1). Then, we will conduct a two-wave online survey experiment with 3,000 older women to examine the combined effects of consistent and conflicting messages from different sources—including clinicians, social relationships, and the news media — on breast cancer screening beliefs, attitudes, and intentions over time (Aim 2). Lastly, we will conduct focus groups with multi-disciplinary stakeholders to devise strategies to deliver the messages from Aim 2 that most effectively reduced over-screening intentions (Aim 3). The proposed project will identify effective messaging strategies to promote appropriate screening cessation and reduce over-screening for breast cancer in older women and engage stakeholders to inform message dissemination. The results will directly inform a communication intervention as a next step to reduce breast cancer over-screening among older women.