New guidelines advise a shared decision-making process between women and their clinicians for screening mammography, especially for women between ages 35 and 50. But most guidelines leave healthcare providers in the dark as to how to do it, according to a study published online July 20 in the Journal of General Internal Medicine.
Existing guidelines don't necessarily offer physicians specific tips for discussing breast cancer screening with patients, and they certainly don't emphasize that women should understand they have a choice about undergoing breast cancer screening, wrote a team led by Lori DuBenske, PhD, of the University of Wisconsin-Madison.
"The clinician needs to be explicit in telling a woman that she has a choice about whether to get a mammogram and the benefits and harms of screening mammography ... [and] to be aware of sociocultural factors that can influence their relationships and their patients' decision-making processes," the group wrote.
DuBenske's team reviewed clinical literature to identify key elements of shared decision-making guidelines on breast cancer screening. The group searched the Cochrane Database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, PubMed, Scopus, and SocIndex for original studies from peer-reviewed publications dated 2009 or later that reported on breast cancer screening, medical decision-making, and patient-centered care.
The researchers found the following key elements of shared decision-making for screening mammography:
- Information delivery/patient education about the benefits and risks of mammography: "Formats such as absolute risk reduction ... descriptive, everyday language rather than technical jargon, visual aid, and real-world examples are preferred by women, benefit comprehension, and facilitate shared decision-making," they wrote.
- Interpersonal clinician-patient communication: "Important roles for clinicians include assessing the woman's information understanding and exploring personal preferences," the researchers noted. "The clinician's demeanor, including enthusiasm, encouragement, and responsiveness to concerns, can facilitate effective shared decision-making."
- Framework of the decision, including sociocultural factors beyond direct shared decision-making: "The basic framework for the decision relies on the woman understanding that she has a choice whether to have a mammogram and that there are factors to consider in making that choice," DeBenske and colleagues wrote. "Beyond education and communication ... many sociocultural factors impact shared decision-making, including race, ethnicity, trust of the medical system, ... and perceived risk for breast cancer."
DuBenske and colleagues believe their study findings highlight the importance of personal patient, clinician, and sociocultural factors that influence breast cancer shared decision-making.
"Expanding the basic tenets of shared decision-making, our findings underscore the importance of the relationship between the patient and the clinician and the necessity of spelling out each step in the shared decision-making process," the group concluded.
