Evidence map›Paper›PMID 28988168›Full record

Trial reportBMJ open2017

How information about overdetection changes breast cancer screening decisions: a mediation analysis within a randomised controlled trial.

Jolyn Hersch, Kevin McGeechan, Alexandra Barratt, Jesse Jansen, Les Irwig, Gemma Jacklyn, Nehmat Houssami, Haryana Dhillon, Kirsten McCaffery

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jolyn HerschSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0001-5225-6639
Kevin McGeechanSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Alexandra BarrattSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Jesse JansenSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Les IrwigSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Gemma JacklynSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Nehmat HoussamiSchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Haryana DhillonCentre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
Kirsten McCafferySchool of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesIn a randomised controlled trial, we found that informing women about overdetection changed their breast screening decisions. We now present a mediation analysis exploring the psychological pathways through which study participants who received the intervention processed information about overdetection and how this influenced their decision-making. We examined a series of potential mediators in the causal chain between exposure to overdetection information and women's subsequently reported breast screening intentions.

designSerial multiple mediation analysis within a randomised controlled trial.

settingNew South Wales, Australia.

participants811 women aged 48-50 years with no personal history of breast cancer.

interventionsTwo versions of a decision aid giving women information about breast cancer deaths averted and false positives from mammography screening, either with (intervention) or without (control) information on overdetection. MAIN OUTCOME: Intentions to undergo breast cancer screening in the next 2-3 years. MEDIATORS: Knowledge about overdetection, worry about breast cancer, attitudes towards breast screening and anticipated regret.

resultsThe effect of information about overdetection on women's breast screening intentions was mediated through multiple cognitive and affective processes. In particular, the information led to substantial improvements in women's understanding of overdetection, and it influenced-both directly and indirectly via its effect on knowledge-their attitudes towards having screening. Mediation analysis showed that the mechanisms involving knowledge and attitudes were particularly important in determining women's intentions about screening participation.

conclusionsEven in this emotive context, new information influenced women's decision-making by changing their understanding of possible consequences of screening and their attitudes towards undergoing it. These findings emphasise the need to provide good-quality information on screening outcomes and to communicate this information effectively, so that women can make well-informed decisions. TRIAL REGISTRATION NUMBER: This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613001035718) on 17 September 2013.

Indexed as

Access to InformationDecision MakingHealth Knowledge, Attitudes, PracticeMedical OveruseAttitude to DeathBreastBreast NeoplasmsDecision Support TechniquesEarly Detection of CancerEmotionsFalse Positive ReactionsFemaleHumansInformed ConsentIntentionMammographybreast imagingcancer screeningdecision aidinformed decision makingmediationoverdiagnosis

Identifiers

PMID28988168
PMCPMC5640026

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.