The perceived ethical appropriateness of messaging on breast cancer screening cessation among older women

Objective

Messaging about breast cancer screening cessation may reduce over-screening by raising awareness of the harms of screening, but in a background of strongly positive beliefs about screening among the public, such messaging may be perceived negatively. We aimed to assess whether older women perceived it to be ethically appropriate for clinicians to share a message that encourages breast cancer screening cessation.

Methods

As part of a large national online survey experiment with women 65+ years, we presented a message (hereafter referred to as primary message) describing the rationales for stopping breast cancer screening (e.g., guideline recommendation, harms of screening) and assessed how ethical women thought it would be for doctors to share this information with patients. We assessed open-ended reactions. We also tested two variations of the primary message with different wordings of the recommendation to consider stopping screening.

Results

Of 683 participants, 75.9 % agreed that the primary message is ethically appropriate for doctors to share with patients., 13.2 % neither agree or disagree, and 10.9 % disagreed. Themes in open-ended responses suggested that the difference in participant response was partly attributed to whether participants perceived the message as informative or persuasive. Comparing across message variations, messages with stronger recommendations to stop screening were perceived to be less ethically appropriate than the primary message.

Conclusions

Most older women perceived that it was ethically appropriate for doctors to share messages aimed at reducing breast cancer over-screening with patients.

Practice Implications

Interventions should be developed to deliver messages to reduce over-screening among older women in practice settings, with evaluations to monitor their response.