Skip to main content

Advertisement

Log in

A randomized trial of three videos that differ in the framing of information about mammography in women 40 to 49 years old

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To assess the effect of providing structured information about the benefits and harms of mammography in differing frames on women’s perceptions of screening.

DESIGN: Randomized control trial.

SETTING: General internal medicine academic practice.

PARTICIPANTS: One hundred seventy-nine women aged 35 through 49.

INTERVENTION: Women received 1 of 3 5-minute videos about the benefits and harms of screening mammography in women aged 40 to 49. These videos differed only in the way the probabilities of potential outcomes were framed (positive, neutral, or negative).

MEASUREMENTS AND MAIN RESULTS: We measured the change in accurate responses to questions about potential benefits and harms of mammography, and the change in the proportion of participants who perceived that the benefits of mammography were more important than the harms. Before seeing the videos, women’s knowledge about the benefits and harms of mammography was inaccurate (82% responded incorrectly to all 3 knowledge questions). After seeing the videos, the proportion that answered correctly increased by 52%, 43%, and 30% for the 3 knowledge questions, respectively, but there were no differences between video frames. At baseline, most women thought the benefits of mammography outweighed the harms (79% positive frame, 80% neutral frame, and 85% negative frame). After the videos, these proportions were similar among the 3 groups (84%, 81%, 83%, P=.93).

CONCLUSIONS: Women improved the accuracy of their responses to questions about the benefits and harms of mammography after seeing the videos, but this change was not affected by the framing of information. Women strongly perceived that the benefits of mammography outweighed the harms, and providing accurate information had no effect on these perceptions, regardless of how it was framed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wells J, Marshall P, Crawley B, Dickersin K. Newspaper reporting of screening mammography. Ann Intern Med. 2001;135:1029–37.

    PubMed  CAS  Google Scholar 

  2. Ernster VL. Mammography screening for women aged 40 through 49—a guidelines saga and a clarion call for informed decision making. Am J Public Health. 1997;87:1103–6.

    Article  PubMed  CAS  Google Scholar 

  3. Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:347–60.

    PubMed  Google Scholar 

  4. Ransohoff DF, Harris RP. Lessons from the mammography screening controversy: can we improve the debate? Ann Intern Med. 1997;127:1029–34.

    PubMed  CAS  Google Scholar 

  5. Pauker SG, Kassirer JP. Contentious screening decisions: does the choice matter? N Engl J Med. 1997;336:1243–4.

    Article  PubMed  CAS  Google Scholar 

  6. Kerlikowske K. Efficacy of screening mammography among women aged 40–49 years and 50–69 years: comparison of relative and absolute benefit. J Natl Cancer Inst Monogr. 1997;22:79–86.

    PubMed  Google Scholar 

  7. Napoli M. What do women want to know? J Natl Cancer Inst Monogr. 1997;22:11–3.

    PubMed  Google Scholar 

  8. Fletcher SW. Breast cancer screening among women in their forties: an overview of the issues. J Natl Cancer Inst Monogr. 1997;22:5–9.

    PubMed  Google Scholar 

  9. Harris R, Leininger L. Clinical strategies for breast cancer screening: weighing and using the evidence. Ann Intern Med. 1995;122:539–47.

    PubMed  CAS  Google Scholar 

  10. Rimer BK. Putting the ‘informed’ in informed consent about mammography. J Natl Cancer Inst. 1995;87:703–4.

    Article  PubMed  CAS  Google Scholar 

  11. Schwartz LM, Woloshin S, Welch HG. Risk communication in clinical practice: putting cancer in context. J Natl Cancer Inst Monogr. 1999;25:124–33.

    PubMed  Google Scholar 

  12. Lawrence VA, Streiner D, Hazuda HP, Naylor R, Levine M, Gafni A. A cross-cultural consumer-based decision aid for screening mammography. Prev Med. 2000;30:200–8.

    Article  PubMed  CAS  Google Scholar 

  13. Black WC, Nease RF, Tosteson ANA. Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst. 1995;87:720–31.

    Article  PubMed  CAS  Google Scholar 

  14. Lerman C, Lustbader E, Rimer B, et al. Effects of individualized breast cancer risk counseling: a randomized trial. J Natl Cancer Inst. 1995;87:286–92.

    Article  PubMed  CAS  Google Scholar 

  15. Silverman E, Woloshin S, Schwartz LM, Byram SJ, Welch HG, Fischhoff B. Women’s views on breast cancer risk and screening mammography: a qualitative interview study. Med Decis Making. 2001;21:231–40.

    Article  PubMed  CAS  Google Scholar 

  16. Rubin R. The breast cancer scare. US News & World Report. 1993;68–72.

  17. Slaytor EK, Ward JE. How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets. BMJ. 1998;317:263–4.

    PubMed  CAS  Google Scholar 

  18. Burke W, Olsen AH, Pinsky LE, Reynolds SE, Press NA. Misleading presentation of breast cancer in popular magazines. Eff Clin Pract. 2001;4:58–64.

    PubMed  CAS  Google Scholar 

  19. Schwartz LM, Woloshin S, Black WC, Welch HG. The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med. 1997;127:966–72.

    PubMed  CAS  Google Scholar 

  20. Rimer BK, Halabi S, Sugg Skinner C, et al. The short-term impact of tailored mammography decision-making interventions. Patient Educ Couns. 2001;43:269–85.

    Article  PubMed  CAS  Google Scholar 

  21. Edwards A, Elwyn G, Covey J, Matthews E, Pill R. Presenting risk information—a review of the effects of ‘framing’ and other manipulations on patient outcomes. J Health Commun. 2001;6:61–82.

    Article  PubMed  CAS  Google Scholar 

  22. Levin IP, Schneider SL, Gaeth GJ. All frames are not created equal: a typology and critical analysis of framing effects. Organ Behav Hum Decis Process. 1998;76:149–88.

    Article  PubMed  Google Scholar 

  23. McNeil BJ, Pauker SG, Sox HC Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982;306:1259–62.

    Article  PubMed  CAS  Google Scholar 

  24. O’Connor AM, Pennie RA, Dales RE. Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. J Clin Epidemiol. 1996;49:1271–6.

    Article  PubMed  CAS  Google Scholar 

  25. Jacoby A, Baker G, Chadwick D, Johnson A. The impact of counselling with a practical statistical model on patients’ decision-making about treatment for epilepsy: findings from a pilot study. Epilepsy Res. 1993;16:207–14.

    Article  PubMed  CAS  Google Scholar 

  26. Llewellyn-Thomas HA, McGreal MJ, Thiel EC. Cancer patients’ decision making and trial-entry preferences: the effects of ‘framing’ information about short-term toxicity and long-term survival. Med Decis Making. 1995;15:4–12.

    Article  PubMed  CAS  Google Scholar 

  27. Friedman LC, Neff NE, Webb JA, Latham CK. Age-related differences in mammography use and in breast cancer knowledge, attitudes, and behaviors. J Cancer Educ. 1998;13:26–30.

    PubMed  CAS  Google Scholar 

  28. Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med. 1998;338:1089–96.

    Article  PubMed  CAS  Google Scholar 

  29. Lerman C, Trock B, Rimer B, Jepson C, Brody D, Boyce A. Psychological side effects of breast cancer screening. Health Psychol. 1991;10:259–67.

    Article  PubMed  CAS  Google Scholar 

  30. NIH, Consensus Statement. Breast cancer screening for women ages 40–49, 1997.

  31. Grimes DA, Snively GR. Patients’ understanding of medical risks: implications for genetic counseling. Obstet Gynecol. 1999;93:910–4.

    Article  PubMed  CAS  Google Scholar 

  32. Costantino JP, Gail MP, Pee D, et al. Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst. 1999;91:1541–8.

    Article  PubMed  CAS  Google Scholar 

  33. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879–86.

    Article  PubMed  CAS  Google Scholar 

  34. Rockhill B, Spiegelman D, Byrne C, Hunter DJ, Colditz GA. Validation of the Gail et al. model for breast cancer risk prediction and implications for chemoprevention. J Natl Cancer Inst. 2001;93:358–66.

    Article  PubMed  CAS  Google Scholar 

  35. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.

    Article  PubMed  CAS  Google Scholar 

  36. Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1.

    Article  PubMed  CAS  Google Scholar 

  37. Weinstein ND. What does it mean to understand a risk? Evaluating risk comprehension. J Natl Cancer Inst Monogr. 1999;25:15–20.

    PubMed  Google Scholar 

  38. Johnson BB, Slovic P. Presenting uncertainty in health risk assessment: initial studies of its effects on risk perception and trust. Risk Anal. 1995;15:485–94.

    Article  PubMed  CAS  Google Scholar 

  39. Alexander NE, Ross J, Sumner W, Nease RF Jr., Littenberg B. The effect of an educational intervention on the perceived risk of breast cancer. J Gen Intern Med. 1996;11:92–7.

    Article  PubMed  CAS  Google Scholar 

  40. Weinstein ND. Testing four competing theories of health-protective behavior. Health Psychol. 1993;12:324–33.

    Article  PubMed  CAS  Google Scholar 

  41. Rakowski W, Dube CE, Marcus BH, Prochaska JO, Velicer WF, Abrams DB. Assessing elements of women’s decisions about mammography. Health Psychol. 1992;11:111–8.

    Article  PubMed  CAS  Google Scholar 

  42. Bogardus ST Jr, Holmboe E, Jekel JF. Perils, pitfalls, and possibilities in talking about medical risk. JAMA. 1999;281:1037–41.

    Article  PubMed  Google Scholar 

  43. Plous S. The Psychology of Judgement and Decision Making. New York: McGraw-HIll; 1993:22–3.

    Google Scholar 

  44. National Center for Health Statistics. Health, United States. 2002. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hus/listables.pdf #82. Accessed 26 March 2003.

  45. Bastian L, Lipkus I, Kuchibhatla M, et al. Women’s interest in chemoprevention for breast cancer. Arch Intern Med. 2000;161:1639–44.

    Article  Google Scholar 

  46. Schwartz LM, Woloshin S, Sox HC, Fischhoff B, Welch HG. US women’s attitudes to false-positive mammography results and detection of ductal carcinoma in situ: cross-sectional survey. West J Med. 2000;173:307–12.

    Article  PubMed  CAS  Google Scholar 

  47. Nekhlyudov L, Ross-Degnan D, Fletcher SW. Beliefs and expectations of women under 50 years old regarding screening mammography. J Gen Intern Med. 2003;18:182–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carmen L. Lewis MD, MPH.

Additional information

Grant support: This study was supported by the University of North Carolina Lineberger Comprehensive Cancer Center. Drs. Lewis (grant number #00-180-01) and Pignone are supported by the American Cancer Society Cancer Control Career Development Award for Primary Care Physicians. Dr. Sheridan was supported by National Research Services Award PHS#14001-14.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lewis, C.L., Pignone, M.P., Sheridan, S.L. et al. A randomized trial of three videos that differ in the framing of information about mammography in women 40 to 49 years old. J GEN INTERN MED 18, 875–883 (2003). https://doi.org/10.1046/j.1525-1497.2003.21152.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2003.21152.x

Key words

Navigation