Videos can help patients make informed decisions about cancer screening

UMass Medical School study finds novel interventions help patients understand counterintuitive recommendations

By Sandra Gray

UMass Medical School Communications

January 27, 2017
  Kathleen Mazor, EdD, and Roget Luckmann, MD
 

Kathleen Mazor, EdD, and Roger Luckmann, MD, are co-authors on the study.

A new study by UMass Medical School primary care experts finds that videos help patients make informed decisions about controversial breast and prostate cancer screening recommendations.

“People find videos, or basically anything that is story-like, more engaging and ultimately more convincing than materials that simply convey the facts,” explained study co-author Kathleen Mazor, EdD, professor of medicine and associate director of the Meyers Primary Care Institute. “This interpersonal aspect comes through much more strongly via audio and video than text-based decision aids that tend to focus on the facts, without a strong narrative voice or the impression that an actual person is behind the recommendation.”

Published in the January/February issue of the Annals of Family Medicine, the study was undertaken to evaluate novel decision aids designed to help patients trust and accept the evidence-based but controversial United States Preventive Services Task Force’s 2009 recommendation for reduced mammography screening for women aged 40 to 49 years, and its 2012 recommendation against screening for prostate cancer with the PSA blood test. These recommendations are counterintuitive to many individuals, despite evidence that some screening tests may only modestly reduce their chance of dying, and may even result in harm, such as complications from invasive biopsies that may be unnecessary.

Investigators began with the premise that the task force makes trustworthy, evidence-based recommendations. They developed English and Spanish language video presentations of physician–patient conversations about the recommendations, informed by focus groups and the current literature on persuasion and behavior change. The 27 men, aged 50 to 74 years, and 35 women, aged 40 to 49 years, participating in the study saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decision making conflicts.

At the outset, 69 percent of men and 86 percent of women reported wanting screening. Preferences for both prostate cancer screening and mammography changed significantly after viewing the video presentations, but not after viewing the printed decision aids. After viewing the videos, the percentage of men wanting PSA screening declined to 33 and the percentage of women wanting screening declined to 49. Viewing the videos also notably reduced uncertainty about whether to proceed with screening.

“Abundant cognitive research shows that humans are not rational decision-making engines, and most people come in with a set of baseline assumptions that all cancer screening is good because no one wants to get cancer,” said Barry Saver, MD, MPH, professor of family medicine & community health and corresponding author of the study. “This approach offers providers a resource that will help patients make an informed decision.”

The pilot study was conducted in nonclinical settings, so next steps are to test the video interventions in medical setting such as an outpatient clinic where patients receive their routine preventive health care. “The use of videos during office visits or in patients’ homes is definitely experimental at this time,” said co-author Roger Luckmann, MD, MPH, associate professor of family medicine & community health. “It will be challenging to coordinate access to the required hardware, software, space and time to make video viewing routine in primary care.”

The researchers are seeking collaborators for a pragmatic implementation trial that will test how to best use the videos in clinical practice. They further believe their video approach could be applied to other medical care recommendations and choices.

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