Decision-making in Breast Cancer Screening: A Qualitative Exploration of the Match Between Women’s Beliefs and Screening Information in the Netherlands

OBJECTIVE:Decision-making about breast cancer screening requires balanced and understandable information that takes prior beliefs of screening invitees into account.METHODS:In qualitative interviews with 22 Dutch women who were invited for screening for the first time (49-52 years of age, varying health literacy levels), we gained insight in their beliefs on breast cancer and breast cancer screening, and explored how the current screening information matched these beliefs.RESULTS:Breast cancer was perceived as an unpredictable, severe, and uncontrollable disease. Women considered screening as self-evident and an important mean to gain some control over breast cancer. Information on benefits of screening was in line with women's prior beliefs and confirmed women's main reasons to participate. Information about false-positive outcomes, overtreatment, and false negative outcomes did not correspond to women's prior beliefs and this information was generally not considered relevant for decision-making. Preferences for additional information merely concerned practical information on the screening procedure.CONCLUSION:Complex information on the harms of screening does not match women's beliefs and is not taken into account in their decision-making.PRACTICE IMPLICATIONS:Information regarding breast cancer screening could be further aligned to prior beliefs by taking into account values, filling knowledge gaps and correct misconceptions.