{
  "abstract": "Objectives Guidelines regarding cancer screening cessation age vary internationally. Many older adults continue to be screened without being informed of the uncertain potential benefits and increasing potential harms (e.g., overdiagnosis). In Australia, women are no longer invited to screening through the national BreastScreen program after turning 74 but can continue to access free screening. Brief information from BreastScreen explaining recommendations for women aged 75+ years can increase the likelihood of informed breast screening decisions, but there is limited understanding of responses to such information. We examined women’s decisions and reasoning after receiving evidence-based messaging via BreastScreen’s final letter explaining the rationale behind cessation of invitations.Method As part of a randomised online trial, women aged 70–74 years in Australia read a hypothetical scenario where they received a final BreastScreen letter reporting no abnormalities. They were randomised to receive: 1) no rationale for cessation (control); 2) printed-text rationale (e.g., downsides of screening may outweigh benefits after age 74); or 3) animation video rationale. After rating their intention to screen beyond 74 years, participants responded to ‘Why do you say that?’. Using content analysis, we examined responses from intervention groups only (groups 2 and 3) to qualitatively understand how the information impacted women’s decision-making.Results We observed three typologies in participant responses (n=217). First, many women were attached to prior preferences (n=139, 64%). Most intended to continue screening regardless of the information presented (n=111/139, 79.9%), reporting positive screening attitudes or perceived higher risk. Some intended to stop screening (n=28/139, 20.1%), reporting negative screening attitudes or lower perceived risk (e.g., no previous issues). Second, the group who deliberated (n=50, 23%) cited intervention content or perceived benefits/risks in their screening decision to continue or stop, and some were unsure and wanted more explanation to support their decision. Third, some women trusted recommendations (n=28, 13%) and were less active decision-makers, including women who were unsure and desired a doctor’s recommendation or leaned towards stopping due to trust in the current BreastScreen recommendation. The three typologies were not mutually exclusive, with some overlapping trends between groups.Conclusions Different typologies among older women contemplating breast screening cessation highlight the importance of multi-level efforts to improve messaging and support older women’s decision-making. Screening services and trusted cancer organisations should deliver brief messaging explaining recommendations to address ageist beliefs and allow clinicians to prioritise other health concerns in time-limited discussions with older women. However, shared decision making resources should also continue to be made easily accessible, including patient decision aids for women who are deliberating and tools for clinicians to provide individualised recommendations to women who desire one. Limitations of this study include social desirability bias, the hypothetical scenario used and lack of diversity in the sample.",
  "authors": [
    {
      "affiliations": [
        "Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "Jenna Smith"
    },
    {
      "affiliations": [
        "Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "Tara Haynes"
    },
    {
      "affiliations": [
        "Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA"
      ],
      "name": "Mara A Schonberg"
    },
    {
      "affiliations": [
        "The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, Australia"
      ],
      "name": "Nehmat Houssami"
    },
    {
      "affiliations": [
        "BreastScreen NSW, Sydney Local Health District, Sydney, Australia"
      ],
      "name": "Wendy Vincent"
    },
    {
      "affiliations": [
        "Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "Erin Cvejic"
    },
    {
      "affiliations": [
        "Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "Vasi Naganathan"
    },
    {
      "affiliations": [
        "School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands"
      ],
      "name": "Jesse Jansen"
    },
    {
      "affiliations": [
        "The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, Australia"
      ],
      "name": "Rachael H Dodd"
    },
    {
      "affiliations": [
        "General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Australia"
      ],
      "name": "Katharine Wallis"
    },
    {
      "affiliations": [
        "Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "Kirsten J McCaffery"
    }
  ],
  "title": "041 Older women’s decision-making after contemplating messaging about breast cancer screening cessation",
  "uid": "945d8c74-1a8f-54d6-bbce-5aba62c9e40f"
}