A dynamic web-based decision aid to improve informed choice in organised breast cancer screening. A pragmatic randomised trial in Italy

Anna Roberto, Cinzia Colombo, Giulia Candiani, Roberto Satolli, Livia Giordano, Lina Jaramillo, Roberta Castagno, Paola Mantellini, Patrizia Falini, Eva Carnesciali, Mario Valenza, Liliana Costa, Cinzia Campari, Stefania Caroli, Roberto Cosimo Faggiano, Lorenzo Orione, Bruna Belmessieri, Vanda Marchiò, Silvia Deandrea, Anna SilvestriDaniela Luciano, Eugenio Paci, Paola Mosconi

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Improving the quality of information and communication is a priority in organised breast cancer screening and an ethical duty. Programmes must offer the information each woman is looking for, promoting informed decision-making. This study aimed to develop and evaluate a web-based dynamic decision aid (DA).

METHODS: A pragmatic randomised trial carried out in six regional organised screening programmes recruited women at the first invitation receiving DA or a web-based standard brochure (SB). The primary outcome was informed choice measured on knowledge, attitudes, and intentions. Follow-up period: 7-10 days. Secondary outcomes included participation rate, satisfaction, decisional conflict, and acceptability of DA.

RESULTS: Two thousand one hundred and nineteen women were randomised and 1001 completed the study. Respectively, 43.9% and 36.9% in the DA and SB reached the informed choice. The DA gave a 13-point higher proportion of women aware about overdiagnosis compared to SB (38.3% versus 25.2%, p < 0.0001). The percentage of women attending screening was the same: 84% versus 83%. Decisional conflict was significantly lower in the DA group (14.4%) than in the SB group (19.3%).

CONCLUSION: DA increases informed choice. Complete information including the pros, cons, controversies, and overdiagnosis-overtreatment issues boost a woman's knowledge without reducing the rate of actual screening participation.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT03097653.

Original languageEnglish
Pages (from-to)714-721
Number of pages8
JournalBritish Journal of Cancer
Volume123
Issue number5
DOIs
Publication statusPublished - Sep 2020

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