Informed decision making for breast cancer screening among Hong Kong Chinese women: Development and pilot testing of a decision aid

Abstract

BACKGROUND: The breast cancer screening debate continues. A tailored decision-aiding tool or decision aid would be useful for women to enhance informed decision making in early breast cancer detection strategies. However, a culturally relevant decision aid which informs Chinese women of the early breast cancer detection strategies available has not been investigated. We developed and pilot-tested a print-based decision aid on breast cancer screening targeting Hong Kong Chinese women at average risk. METHODS: Between October 2013 and January 2014, we recruited women through a population-based telephone survey with random digit dialing. Eligible participants completed our baseline survey and received an intervention of the decision aid by post. Participants received a follow-up telephone interview after a month (n=90). Data on the acceptability and utilization level of the decision aid and other attributes (including knowledge, preferred control in screening decision, perceived breast cancer risk and perceived anxiety level) were collected, and multivariable regression analyses were conducted. RESULTS: Overall, the response to the decision aid was positive. The majority of participants held the opinion that all or most content of the decision aid was presented clearly (86.7%) and did not demonstrate bias towards any particular screening modality for breast cancer (57.8%). The decision aid was useful in helping women make screening-related decisions (88.9%), and it also attained its expected influence on improving informed decision making without growing the participants’ anxiety level. Despite a lack of statistical significance, women showed a modest increase in their overall mean scores for knowledge towards breast cancer screening. We also observed more active or collaborative participation style in screening decision at follow-up assessment. Older women had significantly lower scores in perceived severity of a breast cancer diagnosis (β=-0.03, 95% CI=-0.06 to -0.01), and more educated women stated significantly lower perceived anxiety about the disease of breast cancer (β=-0.85, 95% CI=-1.47 to -0.24). CONCLUSIONS: Our decision aid was considered to be acceptable and feasible for our Hong Kong Chinese women who need to make an informed decision without increasing in their overall anxiety level.