title: Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions.
abstract: We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009).
  
  
  
  We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict.
  
  
  
  Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P= <.001) for men and -0.50 (P= <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P= .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure.
  
  
  
  Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts Barry.Saver@swedish.org.|Meyers Primary Care Research Institute, Worcester, Massachusetts.|Swedish Family Medicine Residency Cherry Hill, Seattle, Washington.
authors.forename: Barry G
authors.initials: BG
authors.lastname: Saver
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts.|Meyers Primary Care Research Institute, Worcester, Massachusetts.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Roger
authors.initials: R
authors.lastname: Luckmann
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts.|Meyers Primary Care Research Institute, Worcester, Massachusetts.|Veterans Health Administration, HSRD COIN Edith Nourse Rogers Memorial Hospitalo, Bedford, Massachusetts.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cutrona
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Marcela
authors.initials: M
authors.lastname: Hayes
authors.affiliation: Center for Health Impact, Worcester, Massachusetts.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Gorodetsky
authors.affiliation: Center for Health Impact, Worcester, Massachusetts.
authors.forename: Nancy
authors.initials: N
authors.lastname: Esparza
authors.affiliation: University of Massachusetts, Boston, Massachusetts.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bacigalupe
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D018592:Cross-Over Studies; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D010358:Patient Participation; D010565:Persuasive Communication; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D014481:United States; D014741:Video Recording
keywords: cancer screening; clinical decision making; early detection of cancer; mammography; persuasive interventions; prostate cancer