title: Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening.
abstract: BACKGROUND
  Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study.
  
  
  METHODS
  The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests.
  
  
  RESULTS
  After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales (p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant.
  
  
  CONCLUSIONS
  Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.
authors.affiliation: 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Eden
authors.affiliation: 2 Marin General Hospital , Greenbrae, California.
authors.forename: Paula
authors.initials: P
authors.lastname: Scariati
authors.affiliation: 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.
authors.forename: Krystal
authors.initials: K
authors.lastname: Klein
authors.affiliation: 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Watson
authors.affiliation: 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon.
authors.forename: Mark
authors.initials: M
authors.lastname: Remiker
authors.affiliation: 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hribar
authors.affiliation: 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Forro
authors.affiliation: 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon.
authors.forename: LeAnn
authors.initials: L
authors.lastname: Michaels
authors.affiliation: 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.|4 Providence Cancer Center , Providence Health and Services, Portland, Oregon.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Nelson
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008327:Mammography; D008875:Middle Aged; D010358:Patient Participation