Examination of Australian women's intentions and psychological outcomes related to breast density notification with mammography screening results: An online randomised experiment

This study aims to quantitively assess how different formats of information provision on breast density affect women’s screening intentions, psychological outcomes (anxiety and breast cancer worry) and knowledge of breast density. This study will use a 3-arm randomised trial design. This trial will be conducted online through a survey platform. An online sample of Australian women (outside of Western Australia) will be recruited through a large market research organisation. Women will be aged between 40 to 74 years with no prior history of breast cancer or ductal carcinoma in situ (DCIS). Women will not be required to have undergone screening mammogram prior to participating in this study. Women will be presented with a hypothetical scenario in which they were asked to imagine going for a routine mammogram screening and receiving a letter about their mammogram results. Women then will be randomised to be shown one of three example letters (written format) about mammography results. Arm 1: Control group (standard screening mammogram result) Women in the control group will be shown a standard screening mammogram result letter, which will show a “clear” result, i.e., no breast cancer could be seen on the mammogram. This letter will be similar to the ones that breast screening services in Australia send out to women with ‘clear’ results. Arm 2: Intervention 1 (standard screening mammogram result + existing breast density notification messaging (e.g. WA)) Women in the intervention 1 will be shown the same letter as the control group, along with an additional breast density notification letter for women with dense breasts. This breast density letter will be identical to the ones that screening services in Western Australia send out to women who are found to have dense breast tissue. This letter includes information that the woman’s breast tissue is dense, followed by information on what breast density means, its implications and following up with a GP. Arm 3: Intervention 2 (standard screening mammogram + health literacy sensitive breast density messaging) Women in the intervention 2 will be shown the same letter as the control group, along with an additional breast density notification letter for women with dense breasts. This letter will be developed by the research team and will be health literacy appropriate, i.e. tailored for a reading level of grade 8. It will also incorporate health literacy strategies such as avoiding complex medical terminologies, using spaces and images or icons. This letter will include information such as woman's breast density level, what is breast density and its implications, what can be done, what are the pros and cons of additional testing and speaking with a healthcare provider. The online intervention will be administered once only with no repeat or subsequent sessions upon completion. It will take 10-15 minutes for participants to take part in the study. Adherence to the intervention will be ensured by forcing a response for outcome measurement items that follow the intervention and by monitoring the overall time taken to complete the online study.