Abstract
BACKGROUND: Whether to continue breast cancer screening beyond age 74 is uncertain. Decision aids may improve understanding of health information and support informed screening decisions. The goal of this study was to develop a video-based decision aid for breast cancer screening among older women using patient-centered design.
METHODS: Following the Framework for Innovation, the research team first used formative focus groups to understand older women's perspectives on mammography. We developed a prototype video based on decision aid best practices and formative focus group findings. We then evaluated the content, clarity, and style of the decision aid in cognitive testing focus groups. We made iterative changes to the video in response to focus group feedback. Focus groups included women age ≥ 70 without a personal history of breast cancer from Connecticut-area community and clinical settings. We coded and analyzed transcripts using both abductive and deductive approaches.
RESULTS: We convened 6 formative focus groups and 7 cognitive testing groups with 31 participants (mean age 78 [range 70-93]); 39% Black, 58% White, and 3% Latina. In focus groups, participants perceived screening as largely beneficial and saw overdiagnosis as unfamiliar. Some participants valued quantitative information about risks and benefits of screening, while others relied on experience, perceptions of risk, and beliefs about the efficacy of mammography to make screening decisions. We incorporated these perspectives into the framing, language, and narrative arc of the decision aid. In cognitive testing focus groups, participants found the decision aid informative and engaging.
DISCUSSION: Using a patient-centered approach, we developed a video-based decision aid for breast cancer screening for older women. Our design, which drew on the perspectives of older women, was perceived as easy to understand and informative. We will assess the impact of the decision aid on decision quality, decisional conflict, and intention to screen in future work.