Multilevel Factors Impacting Mammography Screening Decisions in the Elderly: A Clinician and Patient Pilot

Background For women age 75 and older, there is insufficient evidence to recommend routine breast cancer screening, as the benefits may not outweigh harms. The objective of this study was to identify variables that clinicians consider influential when making screening mammography recommendations for these women and to assess the acceptability and feasibility of a patient print intervention designed to support patient decision-making and patient-clinician communication about stopping mammography. Methods Primary care clinicians who were part of a practice-based research network and patients aged 74–85 from this network completed surveys online and by phone, respectively. Results Twenty-two clinicians (18% response rate) completed the survey. The mean age at which clinicians reported that they would stop recommending screening mammography was 77.14 years. Clinicians were most likely to cite patient comorbidity [86.4%], functional status [77.3%], and cancer family history [63.6%], as well as U.S. Preventive Services Task Force (USPSTF) guidelines [81.8%] and new research regarding screening mammography [77.3%] as factors influencing their recommendations. Fourteen patients (70% enrollment rate) completed baseline surveys and received personalized booklets. Eleven (79% retention) completed follow-up surveys, reporting high intervention acceptability. Decreases in perceived breast cancer risk were significant for lifetime perceived risk (M = 26.91 vs. 4.18, p = < 0.01). Cancer worry decreased slightly (M = 1.27 vs. 1.09, p = 0.77). Conclusions An intervention that addresses a patients’ cancer risk and comorbidities that aligns with USPSTF guidelines appears feasible and acceptable to patients and aligns with clinicians’ values.