||5R37CA254926-03 Interpret this number
||University Of Colorado Denver
||Understanding Affective Processing of Scientific Evidence to Promote Informed Choice for Breast Cancer Screening
Cancer screening for the right patients at the right level of cancer risk can save lives, but over the last several
years many expert groups have de-intensified mammography screening recommendations because of
evidence of net harm for certain populations. Newer recommendations for mammography screening highlight a
tailored approach based on age and risk and comorbidities, aiming to minimize harms and reach women who
could benefit the most. For example, according to the United States Preventive Services Task Force
guidelines, women age 40-49 should talk with their doctor and make an informed choice about whether to
initiate screening. The change in emphasis from strongly promoting annual mammograms for all women over
40 to promoting informed choice in this age group constitutes a medical reversal, in the sense that this new
message is very different from past messages and people’s expectations. Moreover, the recommendation for
informed choice can elicit negative reactions in some women. Many women express disbelief when told about
overdiagnosis and overtreatment, which are significant harms of screening. The notion of risk-based
screening—that is, creating a screening plan tailored to a woman’s objective cancer risk—can raise suspicions
of healthcare rationing. The result is a delicate situation in which there is need to convey the evidence to
women so they can make an informed choice, but also a need to do it in a way that maintains credibility and
trust despite this health message reversal. In this research we focus on four types of concerning responses
that women may express in reaction to mammography evidence: Reactance (i.e. perceived manipulation or
influence, e.g. “this is trying to ration healthcare”), self-Exemption (e.g., “this doesn’t apply to me”), Disbelief
(e.g., “you can’t believe all the research anyway”), and Source derogation (e.g., “I don’t trust this source”),
which we shorten to REDS. This research will identify affective and cognitive predictors of these reactions, and
identify the consequences of these reactions for screening preferences and shared decision-making. In Aim 1
we will conduct a nationally representative survey of women age 40-49 and test affective and cognitive
predictors of REDS reactions and consequences for screening intentions. In Aim 2 we will conduct a
longitudinal survey and identify how women’s attitudes toward the evidence predicts shared decision making
for mammography in an upcoming primary care appointment, and we will also examine how these attitudes
change over time and are influence by women’s broader social environment. In Aim 3, we will conduct
interviews and focus groups to identify strategies for communicating more effectively about screening, to avoid
negative REDS responses, and promote positive responses like empowerment and desire for shared decision
making. We will modify an existing mammography decision aid to incorporate these improvements, and then
conduct randomized pilot tests of these improvements to provide preliminary evidence that they reduce REDS
and improve women’s positive responses to mammography evidence.
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