Women's preference to apply shared decision-making in breast cancer screening: a discrete choice experiment.

OBJECTIVE: To analyse women's stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer screening programmes (BCSP). DESIGN: A discrete choice experiment was designed with 12 questions (choice tasks). It included three attributes: 'How the information is obtained', regarding benefits and harms; whether there is a 'Dialogue for scheduled mammography' between the healthcare professional and the woman; and, 'Who makes the decision', regarding participation in BCSP. Data were obtained using a survey that included 12 choice tasks, 1 question on WTP and 7 socioeconomic-related questions. The analysis was performed using conditional mixed-effect logit regression and stratification according to WTP. SETTING: Data collection related to BCSP was conducted between June and November 2021 in Catalonia, Spain. PARTICIPANTS: Sixty-five women aged between 50 and 60. MAIN OUTCOME MEASURES: Women's perceived utility of each attribute, trade-off on these attributes and WTP for SDM in BCSP. RESULT: The only significant attribute was 'Who makes the decision'. The decision made alone (coefficient=2.879; 95% CI=2.297 to 3.461) and the decision made together with a healthcare professional (2.375; 95% CI=1.573 to 3.177) were the options preferred by women. The former contributes 21% more utility than the latter. Moreover, 52.3% of the women stated a WTP of €10 or more for SDM. Women's preferences regarding attributes did not influence their WTP. CONCLUSIONS: The participant women refused a current paternalistic model and preferred either SDM or informed decision-making in BCSP.

Development of support material for health professionals who are implementing Shared Decision-making in breast cancer screening: validation using the Delphi technique.

BACKGROUND: The Literature is no report support material on Shared Decision-making applied to breast cancer screening that is intended for Spanish health professionals. The researcher created both a handbook and a guide for this topic using an adaption of the Three-talk model. OBJECTIVE: A Delphi method will be used to reach an agreement among experts on the contents and design of a manual and guide, designed by the research team, and to be used by health professionals in the application of SDM in breast cancer screening. DESIGN: A qualitative study. The content and design of the handbook and the guide was discussed by 20 experts. The Delphi techniques was in an online mode between July and October 2020 and researchers used Google forms in three rounds with open and closed questions. The criterion established for consensus was a coefficient of concordance (Cc) above 75, for questions using a Likert scale of 1-6-in which 1 meant 'completely disagree' and 6 'completely agree'-with a cut-off point equal to or higher than 4. RESULTS: Participants considered the Three-talk model suitable for the screening context. The handbook sections and level of detail were considered satisfactory (Cc=90). The summary provided by the clinical practice guide was considered necessary (Cc=75), as it was the self-assessment tool for professionals (Cc=85). Content was added: addressing the limitations of the SDM model; extending the number of sample dialogues for health professionals; providing supplementary resources on using Patient Decisions aids and adding references on communication skills. CONCLUSIONS AND APPLICATIONS: The first handbook and clinical practice guide providing unique SDM support material for health professionals have been developed. The handbook and guide are useful and innovative as supporting material for health professionals, but training strategies for SDM and a piloting plan for the use of materials are requested, in order to facilitate its implementation.

[Breast cancer mortality trend in Spain and its autonomous communities during the period 1980-2005]. / Mortalidad por cáncer de mama: evolución en España y sus comunidades autónomas durante el período 1980-2005.

BACKGROUND: Breast cancer is the most common cancer in women. The aim of this study is to describe the development of breast cancer mortality and its relation with the implementation of population screening programs in Spain and its Autonomous Communities (AC) from 1980 to 2005. METHODS: A breast cancer mortality trends analysis was done. We used the data from mortality of Ministry of Health and Social Policies. We calculated crude, standardized, specific and truncated mortality rates per 100,000 women. Trend analysis was done using a Joinpoint Regression Model to compute the Annual Percentage Change (APC). RESULTS: 131746 people died from breast cancer in Spain between 1980 and 2005. In Spain, mortality rates increased until 1992, when there was a change in the trend (APC = -0.1, -0.9, -0.8 for standard, specific and truncated rates respectively), CONCLUSIONS: Mortality from breast cancer in women in Spain indicates a general downward trend from 1992 to 2005 that was different among the different age groups. This downward trend was also observed in all the AC with some variability in the year that change occurs.

Mortalidad por cáncer de mama: evolución en España y sus comunidades autónomas durante el período 1980-2005 / Breast cancer mortality trend in Spain and its autonomous communities during the period 1980-2005

Fundamentos: El cáncer de mama es el tumor más frecuente enmujeres. El objetivo de este estudio es describir el comportamientode la mortalidad por cáncer de mama en España y en las ComunidadesAutónomas (CCAA) desde 1980 a 2005 y estudiar la relacióncon la implantación de los programas de cribado poblacionales.Métodos: Se ha realizado un análisis de tendencia de la mortalidadpor cáncer de mama a partir de los datos de mortalidad delMinisterio de Sanidad y Política Social. Se calcularon las tasas demortalidad cruda, estandarizada, específica y truncada por 100.000mujeres. El análisis de tendencia se realizó mediante un modelo deregresión joinpoint y se obtuvo el porcentaje de cambio anual (PCA).Resultados: Entre 1980 y 2005 en España se produjeron131.746 defunciones por cáncer de mama. En España las tasas bruta,estandarizada, y truncada, presentaron un comportamiento crecientehasta 1992, año en el que se produjo un cambio de tendencia (PCA=-0,1; -0,9; -0,8 respectivamente).Conclusión: La mortalidad por cáncer de mama en las mujeresen España presenta un cambio de tendencia descendente a partir de1992 que persistió hasta 2005 y que no fue homogénea en todos losgrupos de edad.Esta reducción en la tasa de mortalidad también seobservó en las CCAA con cierta variabilidad en el año donde se produceel cambio(AU)

Background: Breast cancer is the most common cancer inwomen. The aim of this study is to describe the development of breastcancer mortality and its relation with the implementation of populationscreening programs in Spain and its Autonomous Communities(AC) from 1980 to 2005.Methods: A breast cancer mortality trends analysis was done.We used the data from mortality of Ministry of Health and SocialPolicies. We calculated crude, standardized, specific and truncatedmortality rates per 100,000 women. Trend analysis was done using aJoinpoint Regression Model to compute the Annual PercentageChange (APC).Results: 131746 people died from breast cancer in Spain between1980 and 2005. In Spain, mortality rates increased until 1992,when there was a change in the trend (APC = -0.1, -0.9, -0.8 for standard,specific and truncated rates respectively),Conclusions: Mortality from breast cancer in women in Spainindicates a general downward trend from 1992 to 2005 that was differentamong the different age groups. This downward trend was alsoobserved in all the AC with some variability in the year that changeoccurs(AU)