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Background <p>Mammography overscreening, defined as any routine screening in women ≥ 75&#xa0;years, particularly with limited life expectancy, persists.</p> Objective <p>Identify preferences for de-implementing mammography overscreening among older women.</p> Design <p>A national survey using the NORC AmeriSpeak panel, a probability-based panel representative of US households. Informed by qualitative methods, we constructed a discrete choice experiment (DCE) based on a hypothetical patient activation de-implementation strategy (the Rethink Resource) for prompting patient/provider discussions about whether to stop getting mammograms.</p> Participants <p>Women ≥ 70&#xa0;years old selected using sampling strata based on age, race/ethnicity, and education and without a breast cancer history.</p> Main Measures <p>Attributes (levels) included modality (electronic, paper, in-person); context (reviewed with provider, group, on their own); content (mammography pros/cons, patient story/testimonial); frequency (once, yearly); and decision-making principles (age/health calculator, personal preferences/responsibilities checklist). We estimated a random utility model to quantify patient preferences and calculate importance scores.</p> Results <p>There were 673 eligible participants; the weighted mean age was 77.5 (standard deviation: 5.3); 72.0% were Non-Hispanic White, 10.5% Non-Hispanic Black, and 9.8% Hispanic; 69.3% had less than a college degree; 49.6% agreed with the idea of stopping mammography based on age and health. In order of importance, participants preferred (mean [standard error]) the Rethink Resource be reviewed: with their healthcare provider (1.52 [0.08]) or on their own (1.22 [0.07]), include pros/cons (0.79 [0.05]), and be delivered on paper (0.81 [0.07]) or electronically (0.60 [0.07]) on a yearly basis (0.34 [0.05]). There were no significant preferences for decision-making principles (–0.01 [0.05]). </p> Conclusions <p>In the first DCE for de-implementation strategies, we found that women express clear preferences for how and with whom information is relayed, but do not have strong preferences for calculators/checklists.</p>

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Use of a Discrete Choice Experiment to Inform De-implementation of Mammography Overscreening: A US-Based National Survey

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月27日

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  • Nathalie Moise,
  • Dallas Wood,
  • Jennifer Mizhquiri Barbecho,
  • Anita G. Karr,
  • Savannah P. Alexander,
  • Rachel C. Shelton,
  • Parisa Tehranifar

摘要

Background

Mammography overscreening, defined as any routine screening in women ≥ 75 years, particularly with limited life expectancy, persists.

Objective

Identify preferences for de-implementing mammography overscreening among older women.

Design

A national survey using the NORC AmeriSpeak panel, a probability-based panel representative of US households. Informed by qualitative methods, we constructed a discrete choice experiment (DCE) based on a hypothetical patient activation de-implementation strategy (the Rethink Resource) for prompting patient/provider discussions about whether to stop getting mammograms.

Participants

Women ≥ 70 years old selected using sampling strata based on age, race/ethnicity, and education and without a breast cancer history.

Main Measures

Attributes (levels) included modality (electronic, paper, in-person); context (reviewed with provider, group, on their own); content (mammography pros/cons, patient story/testimonial); frequency (once, yearly); and decision-making principles (age/health calculator, personal preferences/responsibilities checklist). We estimated a random utility model to quantify patient preferences and calculate importance scores.

Results

There were 673 eligible participants; the weighted mean age was 77.5 (standard deviation: 5.3); 72.0% were Non-Hispanic White, 10.5% Non-Hispanic Black, and 9.8% Hispanic; 69.3% had less than a college degree; 49.6% agreed with the idea of stopping mammography based on age and health. In order of importance, participants preferred (mean [standard error]) the Rethink Resource be reviewed: with their healthcare provider (1.52 [0.08]) or on their own (1.22 [0.07]), include pros/cons (0.79 [0.05]), and be delivered on paper (0.81 [0.07]) or electronically (0.60 [0.07]) on a yearly basis (0.34 [0.05]). There were no significant preferences for decision-making principles (–0.01 [0.05]).

Conclusions

In the first DCE for de-implementation strategies, we found that women express clear preferences for how and with whom information is relayed, but do not have strong preferences for calculators/checklists.