Ferramenta de apoio à decisão no rastreamento mamográfico para mulheres de 40 a 49 anos
DOI:
https://doi.org/10.5712/rbmfc18(45)3572Palavras-chave:
Mamografia, Comunicação em saúde, Neoplasias da mama, Programas de rastreamento, Uso da informação científica na tomada de decisões em saúde.Resumo
Introdução: O rastreamento do câncer de mama no Brasil é recomendado para as mulheres de 50 a 69 anos, conforme diretrizes nacionais para a detecção precoce do câncer de mama do Instituto Nacional de Câncer/Ministério da Saúde. Embora ele seja tradicionalmente difundido como prática apenas benéfica, as evidências científicas apontam sua complexidade e a necessidade de comunicar o balanço entre os riscos e os benefícios, sobretudo em mulheres mais jovens. Objetivo: Descrever o processo participativo de elaboração de uma ferramenta de apoio à decisão para o rastreamento do câncer de mama quando buscado por mulheres com idade entre 40 e 49 anos no Brasil. Métodos: Estudo qualitativo-participativo que envolveu nove médicos de diferentes estados do Brasil e 104 mulheres na etapa de elaboração e 40 na de avaliação da ferramenta, seguindo as recomendações do International Patient Decision Aid Standards, em quatro etapas: rodas de conversa, síntese de evidências, revisão de ferramentas e avaliação da ferramenta por médicos e mulheres. Resultados: A ferramenta elaborada é inédita no Brasil e todos os médicos que a utilizaram a consideraram útil na conversa sobre os riscos e benefícios do rastreamento; 88,9% avaliaram que as informações facilitaram o entendimento — visão compartilhada por 80% das mulheres — e 77,8% consideraram que reduziu ou não interferiu no tempo de consulta. A ferramenta foi posteriormente aprimorada conforme as críticas e sugestões. Conclusões: O estudo mostrou o alcance do objetivo da ferramenta em oferecer suporte à decisão compartilhada e boa aceitação entre médicos e mulheres.
Downloads
Métricas
Referências
Instituto Nacional de Câncer José Alencar Gomes da Silva. Detecção precoce do câncer [Internet]. Rio de Janeiro: INCA; 2021 [accessed on Jun 11, 2022]. Available at: https://www.inca.gov.br/publicacoes/livros/deteccao-precoce-do-cancer
Mathieu E, Barratt AL, McGeechan K, Davey HM, Howard K, Houssami N. Helping women make choices about mammography screening: an online randomized trial of a decision aid for 40-year-old women. Patient Educ Couns 2010;81(1):63-72. https://doi.org/10.1016/j.pec.2010.01.001 DOI: https://doi.org/10.1016/j.pec.2010.01.001
Hersch JK, Nickel BL, Ghanouni A, Jansen J, McCaffery KJ. Improving communication about cancer screening: moving towards informed decision making. Public Health Res Pract 2017;27(2):2731728. https://doi.org/10.17061/phrp2731728 DOI: https://doi.org/10.17061/phrp2731728
Ivlev I, Hickman EN, McDonagh MS, Eden KB. Use of patient decision aids increased younger women’s reluctance to begin screening mammography: a systematic review and meta-analysis. J Gen Intern Med 2017;32(7):803-12. https://doi.org/10.1007/s11606-017-4027-9 DOI: https://doi.org/10.1007/s11606-017-4027-9
Migowski A, Nadanovsky P, Vianna CMM. Estimation of overdiagnosis in mammographic screening: a critical assessment. Rev Bras Cancerol 2021;67(2):e-151281. https://doi.org/10.32635/2176-9745.RBC.2021v67n2.1281 DOI: https://doi.org/10.32635/2176-9745.RBC.2021v67n2.1281
Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of breast cancer screening: systematic review to update the 2009 U.S. preventive services task force recommendation. Ann Intern Med 2016;164(4):256-67. https://doi.org/10.7326/M15-0970 DOI: https://doi.org/10.7326/M15-0970
Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil [Internet]. Rio de Janeiro: INCA; 2015 [accessed on 12 maio 2023]. Available at: https://bit.ly/3bPqKMP
Instituto Nacional de Câncer. Monitoramento das ações de controle do câncer de mama [Internet]. Informativo Detecção Precoce. Boletim; 2021;12(2) [accessed on Jan 12, 2023]. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/informativo-numero-2-2021.pdf
Urban LABD, Chala LF, Bauab SP, Schaefer MB, Santos RP, Maranhão NMA, et al. Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations. Radiol Bras 2017;50(4):244-9. https://doi.org/10.1590/0100-3984.2017-0069 DOI: https://doi.org/10.1590/0100-3984.2017-0069
De Assis M, Santos ROM, Migowski A. Detecção precoce do câncer de mama na mídia brasileira no Outubro Rosa. Physis 2020;30:e300119. https://doi.org/10.1590/S0103-73312020300119 DOI: https://doi.org/10.1590/s0103-73312020300119
Martínez-Alonso M, Carles-Lavila M, Pérez-Lacasta MJ, Pons-Rodríguez A, Garcia M, Rué M, et al. Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis. BMJ Open 2017;7(10):e016894. https://doi.org/10.1136/bmjopen-2017-016894 DOI: https://doi.org/10.1136/bmjopen-2017-016894
Migowski A. Pink October’s success in Brazil: good news for breast cancer control in the country? Cad Saude Publica 2021;37(11):e00247121. https://doi.org/10.1590/0102-311X00247121 DOI: https://doi.org/10.1590/0102-311x00247121
Hersch JK, Jansen J, Barratt A, Irwig L, Houssami, N, Jacklyn G, et al. Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid. BMJ Open 2014;4:e006016. https://doi.org/10.1136/bmjopen-2014-006016 DOI: https://doi.org/10.1136/bmjopen-2014-006016
Canadian Task Force on Preventive Health Care. Breast Cancer Update–Shared-decision making tool, age 40-49 [Internet]. [accessed on Aug 23, 2022]. Available at: https://canadiantaskforce.ca/tools-resources/breast-cancerupdate/shared-decision-making-tool-age-40-49/
National Health Service. How to decide if you want breast screening [Internet]. 2021 [accessed on Aug 23, 2022]. Available at: https://www.nhs.uk/conditions/breast-screening-mammogram/how-to-decide-if-you-want-breast-screening/
Australian Government. Department of Health and Aged Care. Who should have a breast screen [Internet]. 2019 [accessed on Aug 23, 2022]. Available at: https://www.health.gov.au/our-work/breastscreen-australia-program/having-a-breast-screen/who-should-have-a-breast-screen
Edwards AGK, Naik G, Ahmed H, Elwyn GJ, Pickles T, Hood K, et al. Personalised risk communication for informed decision making about taking screening tests. Cochrane Database Syst Rev 2013;(2):CD001865. https://doi.org/10.1002/14651858.CD001865.pub3 DOI: https://doi.org/10.1002/14651858.CD001865.pub3
Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017;4(4):CD001431. https://doi.org/10.1002/14651858.CD001431.pub5. DOI: https://doi.org/10.1002/14651858.CD001431.pub5
Elwyn G, Burstin H, Barry MJ, Corry MP, Durand MA, Lessler D, et al. A proposal for the development of national certification standards for patient decision aids in the US. Health Policy 2018;122(7):703-6. https://doi.org/10.1016/j.healthpol.2018.04.010 DOI: https://doi.org/10.1016/j.healthpol.2018.04.010
Santos ROM, Abreu MM, Migowski A, Engstrom EM. Ferramenta de apoio à decisão sobre o rastreamento do câncer de próstata no Brasil. Rev Saude Publica 2022;56:19. https://doi.org/10.11606/s1518-8787.2022056003467 DOI: https://doi.org/10.11606/s1518-8787.2022056003467
Martin RW, Andersen SB, O’Brien MA, Bravo P, Hoffmann T, Olling K, et al. Providing balanced information about options in patient decision aids: an update from the international patient decision aid standards. Med Decis Making 2021;41(7):780-800. https://doi.org/10.1177/0272989X211021397 DOI: https://doi.org/10.1177/0272989X211021397
Migowski A, Silva GA, Dias MBK, Diz MDPE, Sant’Ana DR, Nadanovsky P. Diretrizes para detecção precoce do câncer de mama no Brasil. II – Novas recomendações nacionais, principais evidências e controvérsias. Cad Saúde Pública 2018;34(6):e00074817. https://doi.org/10.1590/0102-311X00074817 DOI: https://doi.org/10.1590/0102-311x00074817
Klarenbach S, Sims-Jones N, Lewin G, Singh H, Thériault G, Tonelli M, et al. Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer. CMAJ 2018;190(49)E1441-51. https://doi.org/10.1503/cmaj.180463 DOI: https://doi.org/10.1503/cmaj.180463
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008. https://doi.org/10.1136/bmj.j4008 DOI: https://doi.org/10.1136/bmj.j4008
Migowski A, Dias MBK, Nadanovsky P, Silva GA, Sant’Ana DR, Stein AT. Diretrizes para detecção precoce do câncer de mama no Brasil. III – Desafios à implementação. Cad Saúde Pública 2018;34(6):e00046317. https://doi.org/10.1590/0102-311X00074817 DOI: https://doi.org/10.1590/0102-311x00046317
DuBenske L, Ovsepyan V, Little T, Schrager S, Burnside E. Preliminary evaluation of a breast cancer screening shared decision-making aid utilized within the primary care clinical encounter. J Patient Exp 2021;8:3743735211034039. https://doi.org/10.1177/23743735211034039 DOI: https://doi.org/10.1177/23743735211034039
Shimizu Filho G, Slomp Junior H, Chong Neto H, Romano VF. Mamografia de rastreamento, atenção primária e decisão compartilhada: a voz das mulheres. Rev APS 2022;25(Supl 2):21-39. https://doi.org/10.34019/1809-8363.2022.v25.35339 DOI: https://doi.org/10.34019/1809-8363.2022.v25.35339
Colombo C, Candiani G, Satolli R, Roberto A, Giordano L, Paci E, et al. "Donnainformata-mammografia": a decision aid developed and validated in the Italian setting. Epidemiol Prev 2021;45(4):281-8. https://doi.org/10.19191/EP21.4.P281.084
Reder M, Soellner R, Kolip P. Do women with high ehealth literacy profit more from a decision aid on mammography screening? Testing the moderation effect of the eHEALS in a randomized controlled trial. Front Public Health 2019;7:46. https://doi.org/10.3389/fpubh.2019.00046 DOI: https://doi.org/10.3389/fpubh.2019.00046
Eden KB, Ivlev I, Bensching KL, Franta G, Hersh AR, Case J, et al. Use of an online breast cancer risk assessment and patient decision aid in primary care practices. J Womens Health (Larchmt) 2020;29(6):763-9. https://doi.org/10.1089/jwh.2019.8143 DOI: https://doi.org/10.1089/jwh.2019.8143
Pérez-Lacasta MJ, Martínez-Alonso M, Garcia M, Sala M, Perestelo-Pérez L, Vidal C, et al. Effect of information about the benefits and harms of mammography on women’s decision making: the InforMa randomised controlled trial. PLoS One 2019;14(3):e0214057. https://doi.org/10.1371/journal.pone.0214057 DOI: https://doi.org/10.1371/journal.pone.0214057
Hild S, Johanet M, Valenza A, Thabaud M, Laforest F, Ferrat E, et al. Quality of decision aids developed for women at average risk of breast cancer eligible for mammographic screening: Systematic review and assessment according to the International Patient Decision Aid Standards instrument. Cancer 2020;126(12):2765-74. https://doi.org/10.1002/cncr.32858 DOI: https://doi.org/10.1002/cncr.32858
Esmaeili M, Ayyoubzadeh SM, Javanmard Z, Kalhori SRN. A systematic review of decision aids for mammography screening: focus on outcomes and characteristics. Int J Med Inform 2021;149:104406. https://doi.org/10.1016/j.ijmedinf.2021.104406 DOI: https://doi.org/10.1016/j.ijmedinf.2021.104406
Gao JP, Jin YH, Yu SF, Wu WF, Han SF. Evaluate the effectiveness of breast cancer decision aids: a systematic review and meta-analysis of randomize clinical trails. Nurs Open 2021;8(5):2091-104. https://doi.org/10.1002/nop2.741 DOI: https://doi.org/10.1002/nop2.741
van den Ende C, Oordt-Speets AM, Vroling H, van Agt HME. Benefits and harms of breast cancer screening with mammography in wo-men aged 40-49 years: a systematic review. Int J Cancer 2017;141(7):1295-306. https://doi.org/10.1002/ijc.30794 DOI: https://doi.org/10.1002/ijc.30794
Santos ROM, Ramos DN, Assis M. Construção compartilhada de material educativo sobre câncer de próstata. Rev Panam Salud Pública 2018;42:e122. https://doi.org/10.26633/RPSP.2018.122 DOI: https://doi.org/10.26633/RPSP.2018.122
Abreu MM, Maia MN, Telles AO, Santos ROM, Gomes MK, Mallet ALR, et al. Advances in Shared Decision Making in Brazil: the role of patient autonomy in curriculum reform, health system and clinical care. Z Evid Fortbild Qual Gesundhwes 2022;S1865-9217(22)00087-3. https://doi.org/10.1016/j.zefq.2022.05.005 DOI: https://doi.org/10.1016/j.zefq.2022.05.005
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Renata Oliveira Maciel dos Santos, Monica de Assis, Arn Migowski
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Ao submeterem um manuscrito à RBMFC, os autores mantêm a titularidade dos direitos autorais sobre o artigo, e autorizam a RBMFC a publicar esse manuscrito sob a licença Creative Commons Atribuição 4.0 e identificar-se como veículo de sua publicação original.
