title: Informed decision making before initiating screening mammography: does it occur and does it make a difference?
abstract: OBJECTIVE
  Informed decision making regarding screening mammography is recommended for women under age 50. To what extent it occurs in clinical settings is unclear.
  
  
  METHODS
  Using a mailed instrument, we surveyed women aged 40-44 prior to their first screening mammogram. All women were members of a large health maintenance organization and received care at a large medical practice in the Greater Boston area. The survey measured informed decision making, decisional conflict, satisfaction, and screening mammography knowledge and intentions to undergo screening.
  
  
  RESULTS
  Ninety-six women responded to the survey (response rate 47%). Overall, women reported limited informed decision making regarding screening mammography, both with respect to information exchange and involvement in the decision process. Less than half (47%) reported discussing the benefits of screening; 23% the uncertainties; and only 7% the harms. About 30% reported discussing the nature of the decision or clinical issue; and 29% reported their provider elicited their preferred role in the decision; 38% their preferences; and 24% their understanding of the information. Women who were uninformed had higher decisional conflict (2.37 vs. 1.83, P=0.005) about screening mammography and were more likely to be dissatisfied with the information and involvement. Women's screening mammography knowledge was limited in most areas; however being presented with information did not diminish their intentions to undergo screening.
  
  
  CONCLUSIONS
  Informed decision making before initiating screening mammography is limited in this setting. There appears to be little indication that information about the benefits and harms decreases women's intentions to undergo screening. Methods to communicate information to women before initiating screening mammography are needed.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston, MA 02215, USA. larissa_nekhlyudov@harvardpilgrim.org
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Rong
authors.initials: R
authors.lastname: Li
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D001900:Boston; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D006125:Group Practice, Prepaid / Q000592:standards; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006279:Health Maintenance Organizations / Q000592:standards; D006801:Humans; D033182:Intention; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016387:Women's Health