{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:13:06Z","timestamp":1790392386644,"version":"4.1.0"},"reference-count":39,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,8,17]]},"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In a randomised controlled trial, we found that informing women about overdetection changed their breast screening decisions. We now present a mediation analysis exploring the psychological pathways through which study participants who received the intervention processed information about overdetection and how this influenced their decision-making. We examined a series of potential mediators in the causal chain between exposure to overdetection information and women\u2019s subsequently reported breast screening intentions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Serial multiple mediation analysis within a randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>New South Wales, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>811 women aged 48\u201350 years with no personal history of breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Two versions of a decision aid giving women information about breast cancer deaths averted and false positives from mammography screening, either with (intervention) or without (control) information on overdetection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>Intentions to undergo breast cancer screening in the next 2\u20133 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Mediators<\/jats:title>\n                    <jats:p>Knowledge about overdetection, worry about breast cancer, attitudes towards breast screening and anticipated regret.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The effect of information about overdetection on women\u2019s breast screening intentions was mediated through multiple cognitive and affective processes. In particular, the information led to substantial improvements in women\u2019s understanding of overdetection, and it influenced\u2014both directly and indirectly via its effect on knowledge\u2014their attitudes towards having screening. Mediation analysis showed that the mechanisms involving knowledge and attitudes were particularly important in determining women\u2019s intentions about screening participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Even in this emotive context, new information influenced women\u2019s decision-making by changing their understanding of possible consequences of screening and their attitudes towards undergoing it. These findings emphasise the need to provide good-quality information on screening outcomes and to communicate this information effectively, so that women can make well-informed decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613001035718) on 17 September 2013.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016246","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T16:36:19Z","timestamp":1715877379000},"page":"e016246","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["How information about overdetection changes breast cancer screening decisions: a mediation analysis within a randomised controlled trial"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5225-6639","authenticated-orcid":false,"given":"Jolyn","family":"Hersch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"McGeechan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Barratt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Les","family":"Irwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Jacklyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehmat","family":"Houssami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haryana","family":"Dhillon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"McCaffery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,10,6]]},"reference":[{"issue":"Suppl 1","key":"2024051613335808000_7.10.e016246.1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1089\/jwh.2014.1509","article-title":"The charge and the challenges of breast cancer screening","volume":"23","author":"Harvey","year":"2014","journal-title":"J Womens Health"},{"key":"2024051613335808000_7.10.e016246.2","unstructured":"Elmore JG . Breast cancer screening: balancing evidence with culture, politics, money, and media. In: Houssami N , Miglioretti D , eds. Breast cancer screening: an examination of scientific evidence. Amsterdam: Elsevier, 2016:1\u201327."},{"key":"2024051613335808000_7.10.e016246.3","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq099"},{"key":"2024051613335808000_7.10.e016246.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61611-0"},{"key":"2024051613335808000_7.10.e016246.5","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1038\/bjc.2016.90","article-title":"Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography","volume":"114","author":"Jacklyn","year":"2016","journal-title":"Br J Cancer"},{"key":"2024051613335808000_7.10.e016246.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2529"},{"key":"2024051613335808000_7.10.e016246.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f87"},{"key":"2024051613335808000_7.10.e016246.8","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr474"},{"key":"2024051613335808000_7.10.e016246.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckp174"},{"key":"2024051613335808000_7.10.e016246.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7540.538"},{"key":"2024051613335808000_7.10.e016246.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2005.09.012"},{"key":"2024051613335808000_7.10.e016246.12","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.13635"},{"key":"2024051613335808000_7.10.e016246.13","doi-asserted-by":"publisher","DOI":"10.1186\/s13058-015-0525-z"},{"key":"2024051613335808000_7.10.e016246.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1401875"},{"key":"2024051613335808000_7.10.e016246.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7250.1635"},{"key":"2024051613335808000_7.10.e016246.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60123-4"},{"key":"2024051613335808000_7.10.e016246.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006016","article-title":"Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid","volume":"4","author":"Hersch","year":"2014","journal-title":"BMJ Open"},{"key":"2024051613335808000_7.10.e016246.18","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s13142-015-0333-0","article-title":"News from the NIH: using an experimental medicine approach to facilitate translational research","volume":"5","author":"Riddle","year":"2015","journal-title":"Transl Behav Med"},{"key":"2024051613335808000_7.10.e016246.19","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.pec.2009.06.010","article-title":"The theory of planned behaviour in a randomized trial of a decision aid on cardiovascular risk prevention","volume":"78","author":"Krones","year":"2010","journal-title":"Patient Educ Couns"},{"key":"2024051613335808000_7.10.e016246.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2010.01517.x"},{"key":"2024051613335808000_7.10.e016246.21","doi-asserted-by":"publisher","DOI":"10.1080\/08870440008400299"},{"key":"2024051613335808000_7.10.e016246.22","unstructured":"Hayes AF . Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. 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