perceive to changing their PSA screening practices. We will then discuss reasons why narrative communication techniques hold promise for achieving the substantial shifts in provider motivation and self-efficacy needed to address the problem of prostate cancer overdiagnosis. We will end by describing a specific web-based intervention employing narrative communication techniques we are developing to motivate and empower physicians to discontinue PSA screening. Title Dr. City Minneapolis Full Name Melissa R. Partin Country USA Affiliation Center for Chronic Disease Outcomes Research Phone 612-467-3841 Institutional Address Minneapolis VA Medical Center 1 Veterans Drive Minneapolis MN 55417 Fax 612-467-5699 Postal code 55417 E-mail Melissa.partin@va.gov Abstract #88 - WOMEN’S VIEWS ON OVERDIAGNOSIS IN BREAST CANCER SCREENING: A QUALITATIVE STUDY Hersch, J; Barratt, A; Jansen, J; Irwig, L; Houssami, N; Howard, K; Dhillon, H; McCaffery, K University of Sydney; Sydney, NSW, Australia Background: While mammography screening can reduce breast cancer mortality, it also carries a risk of overdiagnosis – an important harm largely unknown to the public at present. Aims: We elicited women’s responses to information about the nature and extent of overdiagnosis in mammography screening, and explored how awareness of overdiagnosis might influence screening attitudes and intentions. Methods: We conducted a qualitative study using focus groups that included a presentation explaining overdiagnosis, incorporating different published estimates of its rate (1–10%, 30%, 50%) and information on the mortality benefit of screening, with guided group discussions. Participants included 50 women aged 40–79 years with no personal history of breast cancer, varying in educational background and previous participation in screening.
University of Sydney; Sydney, NSW, Australia Background: Australian women aged 50-69 years are offered biennial mammography screening. Awareness of overdiagnosis of breast cancer is minimal, yet understanding this important harm is integral to making informed choices. Aims: We aimed to generate evidence regarding how best to communicate with women about overdiagnosis in mammography screening. Methods: After reviewing the literature on overdiagnosis in breast screening, we explained and discussed the risk of overdiagnosis in focus groups with 50 diverse women, exploring their understanding and sources of confusion. Findings informed the development of a draft information booklet for women approaching screening age, which then entered a thorough piloting and refinement process using interviews with women to improve comprehension and acceptability. Results: We will present and discuss key features of the information booklet, for example: Offering choice: Readers are invited to consider whether or not they wish to have screening Illustration to explain the overdiagnosis concept: This helps women understand that screening could lead to a diagnosis and treatment that are not needed ‘Questions you may have’ box: This addresses key questions and misunderstandings relating to overdiagnosis Visualizing risk: A 1000-person diagram illustrates the absolute number of breast cancer diagnoses over 20 years, including the number of overdiagnosed cases based on an estimate derived from randomised trials and applied to current local data Putting overdiagnosis in context: Overdiagnosis is presented alongside other important screening outcomes (breast cancer mortality reduction, false positives) Summary table: This facilitates comparison of outcomes with and without screening Plain language: Choice of words was guided by consumer input, and a glossary defines all medical terms. Conclusions: The process of developing an information booklet for women considering mammography screening identified important design and presentation aspects that can help optimise communication about overdiagnosis in breast cancer and other contexts. Title Ms City Sydney Full Name Jolyn Hersch Country Australia Affiliation School of Public Health, The Phone +612 9036 9042
Background: Panels defining what should be considered a disease traditionally include only doctors. However, it has recently been argued that including the general public in such decisions could be beneficial, particularly as a disease label commonly results in requests for public funding for its treatment. To our knowledge, no study thus far has compared doctors’ and laypeople’s views on definition of disease and the use of public funding for their treatment. Aims: To compare the perceptions of doctors and lay public on the definition of diseases and the willingness to use public-tax revenue for their treatment. Methods: 3000 laypeople and 1500 doctors in Finland were asked to rate their agreement with two sets of 60 statements: “[This state of being] is a disease” and ”[This state of being] should be treated using public tax revenue” using a 5-point Likert scale. Pearson correlation coefficients and kappa statistics were used to compare doctors’ and laypeople’s responses. Results: 51% of doctors (n=741) and 50% of laypeople (n=1 537) responded. Overall, doctors’ and laypeople’ views on what is disease and what should be treated using tax revenue were similar (correlation for both comparisons: 0.93, 95% confidence interval: 0.88, 0.96) though there was large variability in both groups. Agreement was nearly perfect between doctors’ and laypeople’s views on what is disease (kappa: 0.90) and on what should be treated using tax revenue (kappa: 0.82). Considering a difference of > 1.0 point in average values as a threshold, the states that substantial differences in opinion existed between the two groups were dental caries, hip fracture and alcoholic cirrhosis on the former claim and anorexia and alcoholic cirrhosis on the latter (all: doctors > laypeople). Conclusions: Generally, doctors and laypeople agree on disease definition and public funding (Figure). However, there was both intra- and inter-group disagreement, suggesting that representative panels will have to deal with very divergent opinions. Title City Helsinki Full Name Teppo Järvinen Country Finland Affiliation Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland Phone +358-400-246-426 Institutional Address Topeliuksenkatu 5 P.O. Box 266 Fax Postal code 00029 HUS E-mail teppo.jarvinen@uta.fi
Title Healthcare Analyst City Washington, DC Full Name Divya Pamnani Country US Affiliation National Committee on Quality Assurance Phone 202 955 5187 Institutional Address 1100 13th Street, NW, Suite 1000, Washington, DC Fax Postal code 20005 E-mail