Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study
Objectives To explore the experiences of women who have made the decision to decline breast screening and/or breast cancer treatment for overdiagnosis/overtreatment reasons after being invited to the National Health Service Breast Screening Programme (NHS BSP).Design Qualitative interview study usin...
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| Format: | Article |
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e089155.full |
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| author | Natalie Armstrong Alison Pilnick Shavez Jeffers |
| author_facet | Natalie Armstrong Alison Pilnick Shavez Jeffers |
| author_sort | Natalie Armstrong |
| collection | DOAJ |
| description | Objectives To explore the experiences of women who have made the decision to decline breast screening and/or breast cancer treatment for overdiagnosis/overtreatment reasons after being invited to the National Health Service Breast Screening Programme (NHS BSP).Design Qualitative interview study using reflexive thematic analysis.Setting Participants were recruited via social media, online forums and word of mouth. Semi-structured interviews were conducted between May 2021 and April 2022.Participants 20 women aged between 49 and 76 years old who had declined one or more of the following after receiving an invitation to participate in the NHS BSP: (1) screening investigation, that is, mammogram; (2) further investigations, for example, biopsy, ultrasound; (3) treatment, for example, mastectomy, chemotherapy, radiotherapy and (4) any other medical intervention, for example, ongoing medication.Results The three main themes were as follows: (1) the perception that the NHS BSP information was biased towards uptake and so constrained choice; (2) taking an active role in decision-making by considering the benefits and harms of the NHS BSP and (3) navigating potential regret for having declined.Conclusions In-depth understanding of the potential harms of overdiagnosis and overtreatment influenced the decision to decline for these participants and contributed to their dissatisfactions with the way that information was presented in the invitation to the NHS BSP and the women felt confident in their assessments of the benefits and harms. These findings differ from previous studies, which have suggested that the vast majority lack knowledge and understanding of what overdiagnosis and overtreatment are whereas the participants in this study demonstrated high levels of health literacy. Findings have implications for the way informed choice is considered and constructed in relation to the NHS BSP. |
| format | Article |
| id | doaj-art-7727067e4290469184b73056046f75e1 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-7727067e4290469184b73056046f75e12024-12-17T14:50:09ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-089155Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative studyNatalie Armstrong0Alison Pilnick1Shavez Jeffers23 Department of Population Health Sciences, University of Leicester, Leicester, UK2 School of Nursing and Public Health, Manchester Metropolitan University, Manchester, UK1 Diabetes Research Centre, University of Leicester, Leicester, UKObjectives To explore the experiences of women who have made the decision to decline breast screening and/or breast cancer treatment for overdiagnosis/overtreatment reasons after being invited to the National Health Service Breast Screening Programme (NHS BSP).Design Qualitative interview study using reflexive thematic analysis.Setting Participants were recruited via social media, online forums and word of mouth. Semi-structured interviews were conducted between May 2021 and April 2022.Participants 20 women aged between 49 and 76 years old who had declined one or more of the following after receiving an invitation to participate in the NHS BSP: (1) screening investigation, that is, mammogram; (2) further investigations, for example, biopsy, ultrasound; (3) treatment, for example, mastectomy, chemotherapy, radiotherapy and (4) any other medical intervention, for example, ongoing medication.Results The three main themes were as follows: (1) the perception that the NHS BSP information was biased towards uptake and so constrained choice; (2) taking an active role in decision-making by considering the benefits and harms of the NHS BSP and (3) navigating potential regret for having declined.Conclusions In-depth understanding of the potential harms of overdiagnosis and overtreatment influenced the decision to decline for these participants and contributed to their dissatisfactions with the way that information was presented in the invitation to the NHS BSP and the women felt confident in their assessments of the benefits and harms. These findings differ from previous studies, which have suggested that the vast majority lack knowledge and understanding of what overdiagnosis and overtreatment are whereas the participants in this study demonstrated high levels of health literacy. Findings have implications for the way informed choice is considered and constructed in relation to the NHS BSP.https://bmjopen.bmj.com/content/14/12/e089155.full |
| spellingShingle | Natalie Armstrong Alison Pilnick Shavez Jeffers Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study BMJ Open |
| title | Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study |
| title_full | Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study |
| title_fullStr | Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study |
| title_full_unstemmed | Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study |
| title_short | Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study |
| title_sort | decisions to decline breast screening and or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment a qualitative study |
| url | https://bmjopen.bmj.com/content/14/12/e089155.full |
| work_keys_str_mv | AT nataliearmstrong decisionstodeclinebreastscreeningandorbreastcancertreatmentbasedonthepotentialharmsofoverdiagnosisandovertreatmentaqualitativestudy AT alisonpilnick decisionstodeclinebreastscreeningandorbreastcancertreatmentbasedonthepotentialharmsofoverdiagnosisandovertreatmentaqualitativestudy AT shavezjeffers decisionstodeclinebreastscreeningandorbreastcancertreatmentbasedonthepotentialharmsofoverdiagnosisandovertreatmentaqualitativestudy |