An approach to enhance communication about screening mammography in primary care.
OBJECTIVE
Informed decision making for preventive and screening services in primary care is receiving increased emphasis, yet the actual practice of informed decision making in clinical settings is limited. Lack of training, time, and standardized approaches to engage patients in decision making have been cited as barriers. In initiating screening mammography for women in their 40s, most organizations advise clinicians to educate women about the benefits and potential harms of screening, yet provide no practical guidelines on how to do so in clinical practice.


METHODS
We describe an ethically sound, practical model dialogue that may be used to communicate with women in their 40s about initiating screening mammography and include a discussion of the potential benefits and harms. The dialogue is based on a previously described informed decision-making framework, synthesis of evidence from the breast cancer screening and patient-physician communication literature, field testing with practicing academic and community-based general internists and recommendations by health communication experts.


CONCLUSIONS
The dialogue may be used in office and in academic clinical settings to engage women in decision making about initiating screening mammography, to educate them about the potential benefits and harms, and may also serve as a foundation for teaching medical students and residents about patient-centered communication.
Nekhlyudov
Larissa
L
Department of Ambulatory Care and Prevention, Harvard Medical School , Boston, Massachusetts 02215, USA. larissa_nekhlyudov@harvardpilgrim.org
Braddock
Clarence H
CH
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000458:organization & administration* / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States; D016387:Women's Health