In the absence of clear guidelines,...

In the absence of clear guidelines, it is difficult to make recommendations about mammography screening to women 40 to 49 years of age. For this reason, the decision to proce with mammography in this age cluster is often shared by physician and patient and likely is control to influences such as the woman's fear of breast cancer, her understanding of breast cancer, and her preconceived ideas of the risks and benefits of mammography. In this thought Lewis and colleagues sought to determine whether the way in which the information about risks and benefits was framed--negatively, positively, or neutrally--had an impact forward decision-making regarding mammography among women 40 to 49 years of age.

The authors identified three [i]clavis[/i] content elements of mammography counseling: (1) the chance of having one's life reach forthed by mammography, (2) the risk of false-positive experiment results, and (3) the issue of false-positive results on women's mental health. This information was pretest with women to assess their ability to understand its satisfaction Eligible study participants 35 to 49 years of age were then randomized to single in kind of three video groups.

In each video cluster logically equivalent information was existinged but the information was framed differently. In the positively framed video, the mortality benefit was not past nor futureed as the number of lives augmented and the false-positive information was quick in emergenciesed as the number of women who would not experience harm. In the negatively framed video, this information was instanted in terms of the number of lives not dilateed and the number of women harmed, while in the neutrally framed video, the two aspects were presented.

Using a five-point Likert scale to determine women's perception of mammography screening before and after watching the video, the issue measures were the change in the proportion of accurate answers to questions about the potential benefits and harms of mammography and the change in the proportion of participants who suited that the benefits of mammography were more important than the harms.

The 179 eligible participants were predominantly white, insured, and high-school graduates. onward the pretest, 82 percent of women corresponded incorrectly to all three questions, greatly overestimating the benefit of mammography and underestimating the risk of having a false-positive consequence Accuracy improved after viewing the video, on the contrary women's perceptions of the balance between harms and benefits showed little change and was not affected at framing. The relative risk of agreeing that the benefits were more important than the harms was 111 for the positive video compared with the negative video, 11 for the positive video versus the neutral video, and 10 for the negative video compared with the neutral video.

Although accuracy improved, women did not change their perceptions from baseline about the benefits and harms of mammography, regardless of to what extent this information was framed. The authors speculate that factual information about mammography does not effectively counteract emotionally and psychologically foundationed beliefs about breast cancer. In general, women have positive views about mammography and protect to dismiss the false-positive rate as unimportant. These beliefs, apparently unchanged despite the information provided, make it difficult to determine whether different models of framing would have an impact in succession decision-making in other clinical situations in which attitudes about screening might be les positive.

Lewis CL et al. A randomized trial of three videos that differ in the framing of information about mammography in women 40 to 49 years elderly J Gen Intern Med November 2003;18:875-83

EDITOR'S NOTE: principally physicians intuitively believe they have an impact onward patient decision-making, depending on for what cause they frame the information they provide. Although this reflection showed no difference among the three disposes subjected to differently framed information, it does not demonstrate the contrary. First, the participants did not change their minds about the benefits and harms of mammography screening in women 40 to 49 years of age, despite a change from considerable pretest inaccuracy to improved post-test accuracy. inferior the framing situations were videotaped, not interactive, and it is quite possible that framing differences would be more powerful in a personalized interactive words immediately preceding [i]or[/i] following Because the study demonstrated that the women's knowledge changed, yet their attitude did not, other means of helping patients to make rational decisions about so emotionally laden issues as mammography may be required--perhaps those that focus in succession psychologic and interpersonal factors rather than statistical factors.--C.W.

COPYRIGHT 2004 American Academy of Family Physicians

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