Giulia Congedo, Gaia Surya Lombardi, Doris Zjalic, Mattia Di Russo, Emanuele La Gatta, Luca Regazzi, Giuseppe Indolfi, Annamaria Staiano, Chiara Cadeddu
Knowledge, attitudes and behaviours of a sample of Italian paediatricians towards RSV and its preventive strategies: a cross-sectional study
Italian journal of pediatrics
different guideline panels individuals may make different decisions based part preferences preferences intervention viewed consequence relative importance people place expected experienced health outcomes incurs findings considered patient input balancing effect estimates benefits harms reported empirical evidence clinical effectiveness screening programs systematic review update examined relative importance placed patients potential benefits harms mammographybased breast cancer screening inform update 2018 canadian task force preventive health cares guideline screening screened articles previous review search december 2017 updated searches june 19 2023 medline psycinfo cinahl also screened grey literature submissions stakeholders reference lists target population cisgender women adults assigned female birth including transgender men nonbinary persons aged 35 years average moderately increased risk breast cancer studies patients breast cancer eligible healthstate utility data relevant outcomes sought three types data directly disutilities screening curative treatment health states measuring impact outcome ones healthrelated quality life utilities measured scale 0 death 1 perfect health ii preferencebased data outcome tradeoffs indirectly iii relative importance benefits versus harms inferred attitudes intentions behaviors towards screening among patients provided estimates magnitudes benefits harmss screening used machine learning one reviewers least 50 studies reviewed duplicate humans fulltext selection used independent review two humans data extraction risk bias assessments used single reviewer verification main analysis utilities used data utilitybased healthrelated quality life tools eg eq5d patients disutility value 004 considered minimally important value canadian public suitable pooled utilities explored heterogeneity disutilities calculated screening health states different treatment states nonutility data grouped categories based outcomes compared eg tradeoff data participant age judgements net benefit screening portrayed studies thereafter compared contrasted findings considering sample sizes risk bias subgroup findings data knowledge scores created summary statements data set certainty assessments followed grade guidance patient preferences used consensus among least two reviewers eightytwo studies 38 utilities included estimated disutilities 007 positive screening result moderate certainty 003004 false positive fp additional testing resolved negative cancer low certainty 008 untreated screendetected cancer moderate certainty low certainty interval cancer 12 months disutilities mastectomy vs breastconserving therapy chemotherapy vs none low certainty radiation therapy vs none moderate certainty 002003 002004 littletonone respectively though case findings somewhat limited applicability longer term moderate certainty littletono disutility mastectomy versus breastconserving surgerylumpectomy radiation radiation moderate certainty majority 50 possibly large majority 75 women probably accept six cases overdiagnosis prevent one breastcancer death uncertainty indication overdiagnosis fully understood participants cases low certainty evidence suggested large majority may accept screening may reduce breastcancer allcause mortality least presented relatively high rates breastcancer mortality reductions n 2 2 5 fewer per 1000 screened least majority accept prevent one breastcancer death least hundred patients receive fp result 1015 fp resolved biopsy upper limit acceptable number fps evaluated using data studies assessing attitudes intentions screening behaviors across age groups evident women 40s preferences reduced net benefit presented study authors decreased magnitude relatively low netbenefit scenario majority patients 40s may weigh benefits greater harms screening whereas women 50s large majority may prefer screening low certainty evidence ages moderate certainty large majority women 50 years age 50 69 years age usually experienced screening weigh benefits greater harms screening high netbenefit scenario large majority patients aged 7071 years recently screened probably think benefits outweigh harms continuing screen majority women mid70s early 80s may prefer continue screening evidence across range data sources informed patients value potential outcomes breastcancer screening useful decisionmaking recommendations evidence suggests outcomes examined importance women age least possibly substantial among 40s variability across within age groups acceptable magnitude effects across outcomes provision easily understandable information likelihood outcomes may necessary enable informed decision making although studies came wide range countries limited data canada whether findings applied well across ethnographically socioeconomically diverse population protocol available open science framework httpsosfioxngsu