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Table 6 The decision-making process about mammography screening including influencing factors

From: Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women

Article

Tudiver 2002

NAa

Haggerty 2005

• Approximately 30% of physicians said they would order the test if it would take less time than convincing patients that they do not need it.

Meissner 2011

NAa

Smith 2012

• 94% of physicians found patients often or always thought that breast cancer was a serious threat, were aware of screening and wanted to discuss screening mammography.

• Overall approximately 75% of physicians said that lack of time was never or rarely an issue in discussing breast cancer screening with patients aged 40–49.

• 55% of physicians said they discussed the risks and benefits of screening with their patients, and allowed them to decide when screening mammography should be initiated.

Miller 2014

NAa

Kiyang 2015

• 63% of MDs showed strong or very strong intentions to support women in making informed breast cancer screening decisions.

• Perceived behavioral control was most strongly associated with intention to support, followed by attitude, and then social normal.

• Physicians most frequently reported time constraints as a barrier to supporting women, followed by women’s awareness of relevant information.

• The most frequently reported facilitator of supporting women was the availability of decision support tools for physicians and their patients.

• The next most reported facilitators were specific characteristics of targeted women and the physicians’ own knowledge about informed decision-making.

DuBenske 2017

• Physicians reported struggling to discuss screening mammography.

• Four elements had a critical impact on communication between family physicians with patients on the shared decision-making process: (a) Time constraints; (b) Risk (lack of adequate knowledge of risks and ability to communicate risk in an effective format); (c) Guidelines (confusion related to conflicting and changing guidelines); and (d) personal preferences (addressing patient preferences that contradict guidelines and addressing physician’s own biases).

• Physicians reported a concern for time constraints, and noted they act as a barrier on being able to thoroughly consider all risk factors and offer individual recommendations. They also desired efficiency in the screening discussion.

• Physicians report that they do have brief conversations about potential outcomes of screening, yet women in this study reported receiving limited or no information about them.

• Both identify and support patient preference for varying degrees of involvement in decision-making. Both desire women to understand their risks. Both see the value in preparing women for potential call-backs and next steps, however, women report this does not happen whereas many physicians reported that they do discuss this.

• Many women trust their physicians understand guidelines and use them in directing their decision; physicians identify ambiguity in the available guidelines.

Radhakrishnan 2017

NAa

Radhakrishnan 2018

NAa

  1. aNA, not applicable