ArticleJournal of general internal medicine2026
Use of a Discrete Choice Experiment to Inform De-implementation of Mammography Overscreening: A US-Based National Survey.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMammography overscreening, defined as any routine screening in women ≥ 75 years, particularly with limited life expectancy, persists.
objectiveIdentify preferences for de-implementing mammography overscreening among older women.
designA national survey using the NORC AmeriSpeak panel, a probability-based panel representative of US households. Informed by qualitative methods, we constructed a discrete choice experiment (DCE) based on a hypothetical patient activation de-implementation strategy (the Rethink Resource) for prompting patient/provider discussions about whether to stop getting mammograms.
participantsWomen ≥ 70 years old selected using sampling strata based on age, race/ethnicity, and education and without a breast cancer history. MAIN MEASURES: Attributes (levels) included modality (electronic, paper, in-person); context (reviewed with provider, group, on their own); content (mammography pros/cons, patient story/testimonial); frequency (once, yearly); and decision-making principles (age/health calculator, personal preferences/responsibilities checklist). We estimated a random utility model to quantify patient preferences and calculate importance scores.
resultsThere were 673 eligible participants; the weighted mean age was 77.5 (standard deviation: 5.3); 72.0% were Non-Hispanic White, 10.5% Non-Hispanic Black, and 9.8% Hispanic; 69.3% had less than a college degree; 49.6% agreed with the idea of stopping mammography based on age and health. In order of importance, participants preferred (mean [standard error]) the Rethink Resource be reviewed: with their healthcare provider (1.52 [0.08]) or on their own (1.22 [0.07]), include pros/cons (0.79 [0.05]), and be delivered on paper (0.81 [0.07]) or electronically (0.60 [0.07]) on a yearly basis (0.34 [0.05]). There were no significant preferences for decision-making principles (-0.01 [0.05]).
conclusionsIn the first DCE for de-implementation strategies, we found that women express clear preferences for how and with whom information is relayed, but do not have strong preferences for calculators/checklists.
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