title: Development and evaluation of a decision aid on mammography screening for women 75 years and older.
abstract: OBJECTIVE
  Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed.
  
  
  OBJECTIVE
  To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older.
  
  
  METHODS
  We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information.
  
  
  METHODS
  Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated.
  
  
  METHODS
  The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise.
  
  
  METHODS
  Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information.
  
  
  RESULTS
  The median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (≥ 2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful.
  
  
  CONCLUSIONS
  A DA may improve older women's decision making about mammography screening.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Mara A
authors.initials: MA
authors.lastname: Schonberg
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Hamel
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: M Cecilia
authors.initials: MC
authors.lastname: Griggs
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wee
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, Departments of Internal Medicine and Psychology, University of Michigan, and Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography; D010358:Patient Participation; D016387:Women's Health