Reconciling population benefits and women's individual autonomy in mammographic screening: in-depth interviews to explore women's views about 'informed choice'.
OBJECTIVE
To explore women's reactions to 'informed choice' in mammographic screening.


METHODS
Telephone interviews with a convenience sample of 106 women aged 45-70 years recruited from general practices in Sydney.


RESULTS
Many (42%) women preferred an active role in decision-making. Respondents had low scores for 'uncertainty' and 'factors contributing to uncertainty' in response to explicit questions about the decision to have mammographic screening. Yet respondents indicated significantly greater willingness to have a test when the benefit of a 'new' screening test for breast cancer was expressed as relative risk reduction (RRR) (88%) than either absolute risk reduction (ARR) (78%) (McNemar's test: chi(2)1=7.14, p=0.013) or all-cause mortality (53%) (McNemar's test: chi(2)1=35.1, p<0.01). Significantly more respondents considered information about ARR 'new' to them (65%) compared with RRR information (30%) (McNemar's test: chi(2)1=25.83, p<0.01).


CONCLUSIONS
As mammographic screening exposes well women to potential harms for an overall population benefit, it is challenging to ensure 'informed choice'. Our results suggest women will likely appreciate individual consultations as the context in which to share complex information that women in our study agreed they need to know about mammographic screening. Our results also demonstrate that women's willingness as individuals to participate in mammographic screening is influenced by 'framing effect'. Hence, the quantitative content of decision aids to promote 'informed choice' must be comprehensive and balanced.
Davey
Claire
C
Centre for Behavioural Research in Cancer, The Cancer Council Victoria.
White
Victoria
V
Gattellari
Melina
M
Ward
Jeanette E
JE
D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000592:standards* / Q000706:statistics & numerical data; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales; D026684:Personal Autonomy; D011336:Probability; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires