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Randomized Controlled Trial
. 2017 Dec 13;12(12):e0189148.
doi: 10.1371/journal.pone.0189148. eCollection 2017.

Does a decision aid improve informed choice in mammography screening? Results from a randomised controlled trial

Maren Reder  1   2 , Petra Kolip  1
Affiliations
Randomized Controlled Trial

Does a decision aid improve informed choice in mammography screening? Results from a randomised controlled trial

Maren Reder et al. PLoS One. .

Abstract

Background: Decision aids can support informed choice in mammography screening, but for the German mammography screening programme no systematically evaluated decision aid exists to date. We developed a decision aid for women invited to this programme for the first time based on the criteria of the International Patient Decision Aids Standards Collaboration.

Objective: To determine whether a decision aid increases informed choice about mammography screening programme participation.

Methods: A representative sample of 7,400 women aged 50 was drawn from registration offices in Westphalia-Lippe, Germany. Women were randomised to receive usual care (i.e., the standard information brochure sent with the programme's invitation letter) or the decision aid. Data were collected online at baseline, post-intervention, and 3 months follow-up. The primary outcome was informed choice. Secondary outcomes were the constituents of informed choice (knowledge, attitude, intention/uptake), decisional conflict, decision regret, and decision stage. Outcomes were analysed using latent structural equation models and χ2-tests.

Results: 1,206 women participated (response rate of 16.3%). The decision aid increased informed choice. Women in the control group had lower odds to make an informed choice at post-intervention (OR 0.26, 95% CI 0.18-0.37) and at follow-up (OR 0.66, 95% CI 0.46-0.94); informed choices remained constant at 30%. This was also reflected in lower knowledge and more decisional conflict. Post-intervention, the uptake intention was higher in the control group, whereas the uptake rate at follow-up was similar. Women in the control group had a more positive attitude at follow-up than women receiving the decision aid. Decision regret and decision stage were not influenced by the intervention.

Conclusion: This paper describes the first systematic evaluation of a newly developed decision aid for the German mammography screening programme in a randomised controlled trial. Our decision aid proved to be an effective tool to enhance the rate of informed choice and was made accessible to the public.

Trial registration: German Clinical Trials Register DRKS00005176.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort flow diagram.
Fig 2
Fig 2. Predictor model of attitude.
Unstandardised parameters; a to d: constraints over time; intercepts constrained over time and not shown; residual covariances estimated freely and not shown; A: important/unimportant, B: a good thing/a bad thing, C: pleasant/unpleasant, D: beneficial/harmful; group: 0 = control, 1 = DA.
See this image and copyright information in PMC

References

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