Research on the effectiveness of regular Breast Cancer (BCa) screening tests has demonstrated that early detection can reduce BCa mortality significantly. However, older women and ethnic minority women have lower initial screening rates than other groups and, when screened, often do not return for annual, routine screening. This proposal will investigate whether health education materials using concepts from Shared Decision Making(SDM) and tailored to the needs of older African-American women, can lower decisional conflict and fear toward Bca/-mammography tests, change awareness about the need for repeat mammography, and increase intentions to be re-screened.

SDM has been used to help physicians and patients understand risks and benefits of different types of cancer treatment and certain screening tests. Statistics, probabilities, and test characteristics are used in conjunction with patient preferences and values to quantify the risks and benefits associated with a test or treatment. When applied to BCa re-screening, SDM can help patients make a reasoned decision about re-screening, addresses probability of developing BCa, interprets positive and negative test results, and highlights the benefits of re-screening, including whether finding cancer early can make a difference in mortality and morbidity. A key element of SDM is tailoring of re-screening choices and possible outcomes to the individual and her cultural values so that the facts are relevant to her clinical profile, value systems, and preferences. To date SDM concepts have not been adapted adequately for older, underserved minority populations.

In this Small Grant proposal, SDM methodology will be adapted in order to address the social, cultural, and personal barriers of older African-American women and emphasize the benefits of BCa re-screening for these women. SDM concepts will be reformulated so they are personally relevant to the woman and address cultural or family values. In addition, the benefits of BCa re-screening (i.e., reducing chance of cancer death) relative to the benefits of other common preventive medicine measures (i.e., reducing chance of dying from stroke by treating mild hypertension for 5 years) will be compared. A pilot test will compare the impact of SDM materials to standard mailed reminders on psychosocial outcomes including: decisional conflict, knowledge and attitudes about BCa and mammography, and women's intention to be screened in the next 6 months.

R03CA078184

1998-09-30

2000-09-29