Acceptability of a companion patient guide to support expert consensus guidelines on surveillance mammography in older breast cancer survivors

Rachel A Freedman, Anna C Revette, Haley Gagnon, Adriana Perilla-Glen, Molly Kokoski, Saida O Hussein, Erin Leone, Nicole Hixon, Rebeka Lovato, Wendy Loeser, Nancy U Lin, Christina A Minami, Beverly Canin, Barbara LeStage, Meredith Faggen, Philip D Poorvu, Jennifer McKenna, Kathryn J Ruddy, Nancy L Keating, Mara A Schonberg, Rachel A Freedman, Anna C Revette, Haley Gagnon, Adriana Perilla-Glen, Molly Kokoski, Saida O Hussein, Erin Leone, Nicole Hixon, Rebeka Lovato, Wendy Loeser, Nancy U Lin, Christina A Minami, Beverly Canin, Barbara LeStage, Meredith Faggen, Philip D Poorvu, Jennifer McKenna, Kathryn J Ruddy, Nancy L Keating, Mara A Schonberg

Abstract

Purpose: To support shared decision-making, patient-facing resources are needed to complement recently published guidelines on approaches for surveillance mammography in breast cancer survivors aged ≥ 75 or with < 10-year life expectancy. We created a patient guide to facilitate discussions about surveillance mammography in older breast cancer survivors.

Methods: The "Are Mammograms Still Right for Me?" guide estimates future ipsilateral and contralateral breast (in-breast) cancer risks, general health, and the potential benefits/harms of mammography, with prompts for discussion. We conducted in-clinic acceptability testing of the guide by survivors and their clinicians at a National Cancer Institute-designated comprehensive cancer center, including two community practices. Patients and clinicians received the guide ahead of a clinic visit and surveyed patients (pre-/post-visit) and clinicians (post-visit). Acceptability was defined as ≥ 75% of patients and clinicians reporting that the guide (a) should be recommended to others, (b) is clear, (c) is helpful, and (d) contains a suitable amount of information. We also elicited feedback on usability and mammography intentions.

Results: We enrolled 45 patients and their 21 clinicians. Among those responding in post-visit surveys, 33/37 (89%) patients and 15/16 (94%) clinicians would recommend the guide to others; 33/37 (89%) patients and 15/16 (94%) clinicians felt everything/most things were clear. All other pre-specified acceptability criteria were met. Most patients reported strong intentions for mammography (100% pre-visit, 98% post-visit).

Conclusion: Oncology clinicians and older breast cancer survivors found a guide to inform mammography decision-making acceptable and clear. A multisite clinical trial is needed to assess the guide's impact mammography utilization.

Trial registration: ClinicalTrials.gov-NCT03865654, posted March 7, 2019.

Keywords: Decision-making; Guide; Mammogram; Mammography; Older breast cancer survivors.

Conflict of interest statement

Nancy U. Lin reports institutional research funding from Genentech, Merck, Pfizer, Seattle Genetics, AstraZeneca, Zion Pharmaceuticals, and Olema Pharmaceuticals; consultant/advisory board work for Pfizer, Puma, Seattle Genetics, Daiichi Sankyo, AstraZeneca, Prelude Therapeutics, Denali Therapeutics, Olema Pharmaceuticals, Aleta BioPharma, Affinia Therapeutics, Voyager Therapeutics, and Artera, Inc.; royalties from UpToDate; and stock or other ownership interests in Artera Inc. (a startup with no current value, but options only valued at < 5% and < $50,000 will be provided at a later date). The remaining authors declare that they have no conflicts of interest.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Responses for acceptability of the patient guide by clinician (n = 19)

References

    1. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver Tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029–1036. doi: 10.1158/1055-9965.EPI-16-0133.
    1. Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL. Siegel RL (2019) cancer treatment and survivorship statistics. CA Cancer J Clin. 2019;69(5):363–385. doi: 10.3322/caac.21565.
    1. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Female Breast Cancer. (accessed 27 July 2021).
    1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27(17):2758–2765. doi: 10.1200/JCO.2008.20.8983.
    1. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American cancer society/American society of clinical oncology breast cancer survivorship care guideline. J Clin Oncol. 2016;34(6):611–635. doi: 10.1200/JCO.2015.64.3809.
    1. Walter LC, Schonberg MA. Screening mammography in older women: a review. JAMA. 2014;311(13):1336–1347. doi: 10.1001/jama.2014.2834.
    1. United States Preventative Services Task Force Final Recommendation Statement, Jan 11, 2016 .
    1. Freedman RA, Keating NL, Partridge AH, Muss HB, Hurria A, Winer EP. Surveillance mammography in older patients with breast cancer-can we ever stop? A review. JAMA Oncol. 2017;3(3):402–409. doi: 10.1001/jamaoncol.2016.3931.
    1. Freedman RA, Minami CA, Winer EP, Morrow M, Smith AK, Walter LC, Sedrak MS, Gagnon H, Perilla-Glen A, Wildiers H, Wildes TM, Lichtman SM, Loh KP, Brain EGC, Ganschow PS, Hunt KK, Mayer DK, Ruddy KJ, Jagsi R, Lin NU, Canin B, LeStage BK, Revette AC, Schonberg MA, Keating NL. Individualizing surveillance mammography for older patients after treatment for early-stage breast cancer: multidisciplinary expert panel and international society of geriatric oncology consensus statement. JAMA Oncol. 2021;7(4):609–615. doi: 10.1001/jamaoncol.2020.7582.
    1. Freedman RA, Keating NL, Pace LE, Lii J, McCarthy EP, Schonberg MA. Use of surveillance mammography among older breast cancer survivors by life expectancy. J Clin Oncol. 2017;35(27):3123–3130. doi: 10.1200/JCO.2016.72.1209.
    1. Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O’Brien S, Walter LC. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ. 2013;346:e8441. doi: 10.1136/bmj.e8441.
    1. Reuben DB, Tinetti ME. Goal-oriented patient care–an alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777–779. doi: 10.1056/NEJMp1113631.
    1. Colla CH. Swimming against the current–what might work to reduce low-value care? N Engl J Med. 2014;371(14):1280–1283. doi: 10.1056/NEJMp1404503.
    1. Sypes EE, de Grood C, Whalen-Browne L, Clement FM, Parsons Leigh J, Niven DJ, Stelfox HT. Engaging patients in de-implementation interventions to reduce low-value clinical care: a systematic review and meta-analysis. BMC Med. 2020;18(1):116. doi: 10.1186/s12916-020-01567-0.
    1. Berlin NL, Skolarus TA, Kerr EA, Dossett LA. Too much surgery: overcoming barriers to deimplementation of low-value surgery. Ann Surg. 2020;271(6):1020–1022. doi: 10.1097/SLA.0000000000003792.
    1. Schonberg MA, Kistler CE, Pinheiro A, Jacobson AR, Aliberti GM, Karamourtopoulos M, Hayes M, Neville BA, Lewis CL, Wee CC, Fagerlin A, Nekhlyudov L, Marcantonio ER, Hamel MB, Davis RB. Effect of a mammography screening decision aid for women 75 years and older: a cluster randomized clinical trial. JAMA Intern Med. 2020 doi: 10.1001/jamainternmed.2020.0440.
    1. Schonberg MA, Karamourtopoulos M, Jacobson AR, Aliberti GM, Pinheiro A, Smith AK, Davis RB, Schuttner LC, Hamel MB. A strategy to prepare primary care clinicians for discussing stopping cancer screening with adults older than 75 years. Innov Aging. 2020;4(4):igaa027. doi: 10.1093/geroni/igaa027.
    1. Schonberg MA, Jacobson AR, Karamourtopoulos M, Aliberti GM, Pinheiro A, Smith AK, Schuttner LC, Park ER, Hamel MB. Scripts and strategies for discussing stopping cancer screening with adults > 75 years: a qualitative study. J Gen Intern Med. 2020;35(7):2076–2083. doi: 10.1007/s11606-020-05735-z.
    1. Schonberg MA, Hamel MB, Davis RB, Griggs MC, Wee CC, Fagerlin A, Marcantonio ER. Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med. 2014;174(3):417–424. doi: 10.1001/jamainternmed.2013.13639.
    1. Schonberg MA. Decision-making regarding mammography screening for older women. J Am Geriatr Soc. 2016 doi: 10.1111/jgs.14503.
    1. Schonberg MA, Silliman RA, Marcantonio ER. Weighing the benefits and burdens of mammography screening among women age 80 years or older. J Clin Oncol. 2009;27(11):1774–1780. doi: 10.1200/JCO.2008.19.9877.
    1. Schonberg MA, Breslau ES, McCarthy EP. Targeting of mammography screening according to life expectancy in women aged 75 and older. J Am Geriatr Soc. 2013;61(3):388–395. doi: 10.1111/jgs.12123.
    1. Schonberg MA, Walter LC. Talking about stopping cancer screening-not so easy. JAMA Intern Med. 2013;173(7):532–533. doi: 10.1001/jamainternmed.2013.3233.
    1. Schonberg MA, Breslau ES. Mammography screening for women aged 70 and older: at a crossroads. J Am Geriatr Soc. 2015;63(1):170–172. doi: 10.1111/jgs.13189.
    1. Schonberg MA, McCarthy EP, York M, Davis RB, Marcantonio ER. Factors influencing elderly women’s mammography screening decisions: implications for counseling. BMC Geriatr. 2007;7:26. doi: 10.1186/1471-2318-7-26.
    1. Schonberg MA, Kistler CE, Nekhlyudov L, Fagerlin A, Davis RB, Wee CC, Marcantonio ER, Lewis CL, Stanley WA, Crutchfield TM, Hamel MB. Evaluation of a mammography screening decision aid for women aged 75 and older: protocol for a cluster-randomized controlled trial. J Clin Trials. 2014;4:191. doi: 10.4172/2167-0870.1000191.
    1. Schonberg MA, Ramanan RA, McCarthy EP, Marcantonio ER. Decision making and counseling around mammography screening for women aged 80 or older. J Gen Intern Med. 2006;21(9):979–985. doi: 10.1111/j.1525-1497.2006.00487.x.
    1. The Ottawa Hospital. Patient Decision Aids. .
    1. Kincaid JP, Fishburne RP, Rogers RL, Chissom BS (1975) Derivation of new readability formulas (automated readability index, fog count and flesch reading ease formula) for Navy enlisted personnel. Research Branch Report 8–75, Millington, TN: Naval Technical Training, U.S. Naval Air Station, Memphis, TN.
    1. Diet, nutrition, physical activity and cancer: a global perspective (2018).
    1. O’Connor AM. User manual- decisional conflict scale. .
    1. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25–30. doi: 10.1177/0272989X9501500105.
    1. O’Connor AM (1993) User manual: decisional conflict scale (16 item statement format) Ottawa Hospital Research Institute. (accessed 10 Sept 2021).
    1. Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM. Measuring numeracy without a math test: development of the Subjective Numeracy Scale. Med Decis Making. 2007;27(5):672–680. doi: 10.1177/0272989X07304449.
    1. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, Bradley KA, Nugent SM, Baines AD, Vanryn M. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561–566. doi: 10.1007/s11606-008-0520-5.
    1. Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O’Neil J, Bilodeau B, Watson P, Mueller B. Information needs and decisional preferences in women with breast cancer. JAMA. 1997;277(18):1485–1492. doi: 10.1001/jama.1997.03540420081039.
    1. Health Information National Trends Survey (HINTS) 2003, 2005, and 2008.
    1. Andersen MR, Smith R, Meischke H, Bowen D, Urban N. Breast cancer worry and mammography use by women with and without a family history in a population-based sample. Cancer Epidemiol Biomarkers Prev. 2003;12(4):314–320.
    1. Graham ID, O’Connor AM. User manual.

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