Evaluation of a mammography decision aid for women 75 and older at risk for lower health literacy in a pretest-posttest trial.
Tamara Cadet, Gianna Aliberti, Maria Karamourtopoulos and 5 others
PMID 33637391WHAT IT FOUND
In older women at risk for lower health literacy, a plain-language mammography decision aid did not change overall uncertainty about screening, but knowledge of benefits and harms rose from 3.75 to 4.42 correct of 7.
Key findings
01Knowledge increased from 3.75 to 4.42 correct answers out of 7 (p = .03), but post-test scores were worse on two questions, including cancers that would never have shown up or caused problems.
02Overall decisional conflict did not significantly change; item-level changes were small and not significant, with benefits/downsides moving from 0.59 to 0.74 (p = .23), support from 0.77 to 0.84 (p = .69), and certainty from 0.97 to 0.89 (p = .69).
03Most women found the aid acceptable: 93% said the information was clear, 97% said it was helpful, and 91% would recommend it.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Small sample from one geographic area: 43 women, so the results may not apply to older women with lower health literacy elsewhere. Pretest-posttest design with no control group: changes cannot be separated from the routine primary care visit, time, or other influences. Screening intentions were not measured for most women during the study, so the aid's effect on intended or actual screening is unclear. Preferred decision-making role was assessed only after the aid, so changes from baseline cannot be shown. Two knowledge questions were long or double-barreled, and scores worsened on them, so the knowledge test may not have measured those concepts well. Health literacy risk was defined partly by confidence filling out forms and partly by education; 56% reported being extremely confident or quite a bit confident, so some participants may not have had low literacy.
Declared interests
No author conflict-of-interest declaration is included in the supplied text. The publication types list Research Support, N.I.H., Extramural.
The easy way to misread this
Do not conclude that the decision aid caused women to stop screening or reduced overall uncertainty. The study had no control group, the overall decisional conflict score did not significantly change, and only 18 of 43 had a documented screening discussion at 6 months.