The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge

Abstract

Purpose The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits. Method A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured. Results With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions. Conclusions Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.

Patient preferences for breast cancer screening: a systematic review update to inform recommendations by the Canadian Task Force on Preventive Health Care

“…One new study (n = 2,120) at low risk of bias was judged to present a moderate net bene t scenario for this age group (i.e., 2 fewer breast-cancer deaths, 160 FPs and 20 overdiagnoses in 1000 over 11 years) [103]. Though very low certainty for any outcome valuation, the ndings suggested that information on overdiagnosis may be quite important for many women (Supplementary le 3).…”

“…*Reasons for rating down certainty: a = risk of bias, b = inconsistency/lack of consistency, c = indirectness, d = imprecision; the capital C for ratings among 40 to 49-year-olds in the relatively moderate net-bene t scenario indicates very serious concerns for indirectness from the mean age being 49.5 years. 40 49 years Ten studies (N = 7,405, range 12 to 2,918) [73, 74, 84, 87, 90, 93-95, 99, 103], four new to this review (N = 3,814) [84,93,95,103], included patients in their 40s. Five studies were conducted in the US[74,94,95,99,103], and one each conducted in Spain [84], Italy[93], Canada[73], New Zealand[90], and Australia[87].…”

“…40 49 years Ten studies (N = 7,405, range 12 to 2,918) [73, 74, 84, 87, 90, 93-95, 99, 103], four new to this review (N = 3,814) [84,93,95,103], included patients in their 40s. Five studies were conducted in the US[74,94,95,99,103], and one each conducted in Spain [84], Italy[93], Canada[73], New Zealand[90], and Australia[87]. Three studies included a broader age range (n = 1,001, aged 49.7 [SD 3.2] [93]; n = 2,120 aged 49.SD 7.8] [103]; n = 46, aged 35-59 [63% <50] [73]…”

Overscreening for Women’s Cancer: Time for Change

“…I wish my clinicians had offered the best of such resources (e.g., https://www.choosingwisely.org/patient-resources/; https:// www.cochrane.dk/sites/cochrane.dk/files/public/uploads/ images/mammography/mammography-leaflet.pdf; https:// www.informedhealth.org/). Yet, information alone is insufficient for comprehension and can be confusing, as demonstrated by many patients' poor understanding of mammography benefits and risks 27 and overestimation of the likelihood of being diagnosed and dying. 13 In addition, patient communication interventions can lead to counterintuitive results, decreasing the desire for mammography even when net benefits are portrayed.…”

“…13 In addition, patient communication interventions can lead to counterintuitive results, decreasing the desire for mammography even when net benefits are portrayed. 27 Thus, our patient-support tools are not optimal and must be accompanied by physician support tools and shared decision making.…”