Beliefs and expectations of women under 50 years old regarding screening mammography: a qualitative study

Abstract

Objective: Because shared decision making has been recommended for screening mammography by women under age 50, we studied women's decision-making process regarding the procedure.

Design: Qualitative research design using in-depth semi-structured interviews.

Patients: Sixteen white and African-American women aged 38 to 45 receiving care at a large New England medical practice.

Measurements and main results: We identified the following content areas in women's decision-making process: intentions for screening, motivating factors to undergo screening, attitudes toward screening mammography, attitudes toward breast cancer, and preferences for information and shared decision making. In our sample, all women had or intended to have a screening mammogram before age 50. They were motivated by the awareness of the recommendation to begin screening at age 40, knowing others with breast cancer, and a sense of personal responsibility for their health. Participants feared breast cancer and thought the benefits of screening mammography far outweighed its risks. Women's preferences for involvement in decision making varied from wanting full responsibility for screening decisions to deferring to their medical providers. All preferred the primary care provider to be the main source of information, yet the participants stated that their own providers played a limited role in educating them about the risks and benefits of screening and the mammography procedure itself. Most of their information was derived from the media.

Conclusions: The women in this study demonstrated little ambivalence in their desire for mammography screening prior to age 50. They reported minimal communication with their medical providers about the risks and benefits of screening. Better information flow regarding mammography screening is necessary. Given the lack of uncertainty among women's perceptions regarding screening mammography, shared decision making in this area may be difficult to achieve.

FIGURE 1

Conceptual model for women's decision-making process regarding screening mammography, derived from the qualitative interviews. Several factors motivated women to get screened, including the media, others with breast cancer, medical providers, and other factors, as well as women's own psychosocial composition. The role of age 40 was interwoven within each of these factors. Attitudes toward breast cancer and screening mammography were related to the screening decision. Factors inherent in the decision-making process, such as the adequacy of information received, women's preferences for information, and preferred roles in decision making appeared to have little impact on screening decisions.