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Randomized Controlled Trial
. 2017 Jan;15(1):48-55.
doi: 10.1370/afm.1996. Epub 2017 Jan 6.

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

Barry G Saver  1   2   3 , Kathleen M Mazor  4   2 , Roger Luckmann  4 , Sarah L Cutrona  4   2   5 , Marcela Hayes  4 , Tatyana Gorodetsky  6 , Nancy Esparza  6 , Gonzalo Bacigalupe  7
Affiliations
Randomized Controlled Trial

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

Barry G Saver et al. Ann Fam Med. 2017 Jan.

Abstract

Purpose: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: cancer screening; clinical decision making; early detection of cancer; mammography; persuasive interventions; prostate cancer.

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Conflict of interest statement

Conflicts of interest: authors report none.

Figures

Figure 1
Figure 1
Expressed preferences for prostate-specific antigen testing after seeing video, then paper, or vice versa (total n = 27 men aged 50–74 years).
Figure 2
Figure 2
Expressed preferences for mammography testing after seeing video, then paper, or vice versa (total n = 35 women aged 40–49 years).
See this image and copyright information in PMC

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