Impact of Informed Decision Making Booklet On Participation to the National Breast Cancer Screening in France : Results From a Randomized Controlled Trial

  

   Introduction: National breast cancer screening is established in France for women aged of 50 to 74 years. Every other year, these women are invited to perform a mammography. Organized Screening (OS) participation is sought to be of 70% or more although actual participation range around 45%.  

The aim of this study was to assess the impact of a new informed decision tool in two ways:

 - the participation to the national screening for breast cancer

-  the decision making process of invited women.

This new tool (called DECIDEO booklet) is a document giving a complete, accessible to all, and scientifically based information on both advantages and disadvantages of the national breast cancer screening.

   Methods:

The first part of this study was a multicenter randomized controlled trial conducted among 15 584 women aged 50 to 74 years invited to participate to OS. One group received the booklet with the invitation, the other did not.

For the second part, a qualitative phone survey was conducted with a sample of 400 women who received the usual invitation and DECIDEO booklet one month before. The questionnaire was dealing with:

-          the level of knowledge about breast cancer and screening

-          the satisfaction concerning the help to get a decision the DECIDEO booklet brings to them

-          The decision to participate or not to OS

-          Characteristics of the respondents’ women including specific focus on socio-economic characteristics.

 Results:

DECIDEO booklet translate in similar rate of participation to the OS of breast cancer (40.3% intervention vs. 42.1% control group; p = 0.02).
The qualitative survey revealed that only 49% (196) of women recall having received the booklet and that 30% (121) declared having read it.

Women who read the booklet are more educated (p = 0.046) and younger (p = 0.040) than the others. The reading of the booklet was independently associated with an increase of knowledge about cancer and screening (p = 0.002); with a good resolution of the decisional conflict (p = 0.047) and independently associated with an increase of participation to the OS (p = 0.001).

   Conclusions: The DECIDEO booklet was assessed as a satisfactory help for the decision making process. It increases the knowledge level about breast cancer and screening, but mainly among the women with a high socio-economic level.

The question raised is how to use this tool without reinforcing social inequalities in access to screening?