Capsule Commentary on Ivlev et al., Use of Patient Decision Aids Increased Younger Women’s Reluctance to Begin Screening Mammography: A Systematic Review and Meta-Analysis
Capsule Commentary on Ivlev et al., Use of Patient Decision Aids Increased Younger Women's Reluctance to Begin Screening Mammography: A Systematic Review and Meta-Analysis
Amir Mohammad ) 0 1
FACPM 0 1
FACOEM 0 1
0 Compliance with Ethical Standards:
1 Yale University School of Medicine and VA Connecticut Healthcare System , New Haven, CT , USA
C tion are emerging to assist patients making shared
medertified decision aids that use evidence-based
informaical decisions. In this systematic review and meta-analysis, the
authors attempted to address the effectiveness of breast cancer
screening patient decision aids (BCS-PtDAs) and their impact
on screening mammography rates among younger women.
The authors note that breast screening recommendations are
not uniform,1–3 which may further lead to confusion and
inconsistency in following recommended guidelines and
potentially to noncompliance among providers.
After going through the rigorous criteria and utilizing the
Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) approach, the authors included only six
studies in their analysis. However, only three studies used
controlled randomization, and the other three were before–
after studies; decision aids evaluated included written material,
web-based tools, videos, and other multimedia programs.
Of the six selected studies, three were computerized
decision aids and the other three were booklets or pamphlets. This
is timely, as several studies have established the effectiveness
of PtDAs in shared decision making.4 The essential function
of communication in cancer screening is to ensure that patients
make decisions consistent with their preferences, needs, and
values. This study indicates that decision-aid use resulted in
significantly fewer young woman (38–50 years old) opting to
receive screening mammography compared to those who
received usual medical care. This is similar to findings about
men’s PSA screening preferences before and after viewing a
This systematic review adds to our knowledge on the
utility of decision aids/tools as described by the authors.
However, future studies, including randomized controlled
trials (RCT), should be conducted to validate these tools
in different patient population and healthcare settings.
Furthermore, these types of tools and decision aids
should be integrated into the electronic health record
(EHR) to improve population health. Clinicians should
select and utilize the evidence-based tools that help
patients in making screening decisions when no single best
choice is available.
1. Ivlev I , Hickman EN , McDonagh, MS, and Eden KB . Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis . J Gen Intern Med . 2017 . Doi: 10.1007/ 11606 - 017 - 4027 -9.
2. Li J , Shao Z. Mammography screening in less developed countries . Springerplus 2015 ; 4 ( 1 ): 615 . doi:10.1186/s40064- 015 - 1394 -8.
3. Biesheuvel C , Weige S , Heindel W. Mammography screening: evidence, history and current practice in Germany and other European countries . Breast Care . 2011 ; 6 ( 2 ): 104 - 109 .doi:10.1159/000327493.
4. Sepucha KR , Borkhoff CM , Lally J , Levin CA , et al. Establishing the effectiveness of patient decision aids: key constructs and measurement instrument . BMC Med Inform Decis Mak . 2013 ; 13 Suppl 2:S12 . doi: 10. 1186/ 1472 - 6947 - 13 - S2 -S12. Review.
5. Barry MJ , Wexler RM , Brackeet CD , et al. Responses to a Decision Aid on Prostate Cancer Screening in Primary Care Practices . Am J Prev Med . 2015 ; 49 ( 4 ): 520 - 5 .