Creating a Mammography Conversation Aid for Shared Decision-Making Between Clinicians and Women Aged 75 and Older

Guidelines recommend primary care practitioners ("PCPs") engage women ≥ 75 years in shared decision-making (SDM) around mammography screening. Therefore, we aimed to develop a web-based conversation aid about mammography screening for women ≥ 75 using output from established simulation models to provide screening outcomes based on > 23,000 combinations of individual women's health and breast cancer risk factors.

We used an end-user centered design approach to develop a prototype web-based conversation aid incorporating feedback. From July 2023 to April 2024, 10 PCPs from a Boston-area health system and a safety-net hospital used the prototype aid during encounters with women ≥ 75 without breast cancer or dementia (n = 30; 1-5 patients per PCP). We observed aid use and assessed clinician effort to involve patients in SDM using OPTION5 (assesses five components of SDM, scores range 0-100). We surveyed PCPs and patients about the aid's acceptability. Patients completed the SDM-process scale (scores range 0-4) to rate the SDM quality experienced. Participants' comments were subject to thematic analysis.

Of 10 PCP-participants, seven were female and four were community-based. Of 30 patient-participants, 22 (73%) were non-Hispanic White, 9 (30%) had ≥ 2 Charlson comorbidities and mean age was 78.5 years (SD 2.8). Nine PCPs agreed that the aid helped them with SDM and was easy-to-use; six felt it had too much information; and seven planned to continue using the aid. Patients rated the SDM-process highly (scores = 3.0 [SD 0.9]) and we observed high SDM (mean OPTION5 = 77.9 [SD 20.6]). Participants felt the aid was "empowering" and "helpful for decision-making." After SDM discussions, seven patients intended to stop screening, nine to screen less frequently, and 14 to continue screening regularly.

We developed a novel conversation aid that supports SDM about mammography screening with women ≥ 75 years. Lessons learned will guide revisions of a final tool for testing in a clinical trial.