Framing the Clinical Encounter: Shared Decision-Making, Mammography Screening, and Decision Satisfaction

Area of Science:

• Health Communication
• Medical Decision Making
• Patient Engagement

Background:

• Shared decision-making (SDM) is crucial for patient-centered care, especially in screening decisions like mammography.
• Clinical decision support tools (CDSTs) can aid physicians but their impact on SDM satisfaction depends on communication strategies.
• Message framing effects are well-documented in experimental settings but less understood in real clinical encounters.

Purpose of the Study:

• To investigate how physicians' message framing influences patient satisfaction with SDM when using a CDST for mammographic screening.
• To identify specific framing techniques that enhance or diminish SDM satisfaction.
• To bridge the gap between message framing research and clinical practice.

Main Methods:

• Combined data from CDST system logs, physician message content analysis, and post-visit patient surveys.
• Analyzed patient satisfaction with SDM regarding mammographic screening.
• Examined the moderating role of message framing (consequence and numerical frames) on the CDST-patient relationship.

Main Results:

• Positive consequence framing improved cognitive SDM satisfaction when the CDST indicated low breast cancer risk.
• Framing numerical risk information in relative terms, rather than absolute terms, reduced patient SDM satisfaction.
• The effectiveness of CDSTs on SDM satisfaction is contingent on the physician's communication framing.

Conclusions:

• Physicians' message framing significantly impacts patient SDM satisfaction during CDST-assisted mammography screening discussions.
• Positive consequence framing and absolute numerical framing are beneficial for enhancing SDM satisfaction.
• This study emphasizes the need for training physicians in effective risk communication strategies within clinical decision support contexts.