Development and acceptability of gist-based decision aids for prostate and breast cancer screening: a two-phase qualitative interview study in an online setting.

Clinical Snapshot

Key Findings

• P Value: Not reported (qualitative and descriptive quantitative study)

• Effect Size: 94% of Phase 2 participants (45/48) reported they would find the decision aid helpful when making a screening decision

• Primary Outcome: Acceptability and comprehensibility of gist-based decision aids for prostate and breast cancer screening across iterative development phases

• Nnt Or Sensitivity: Not applicable; two-thirds of participants found the length and amount of information optimal; majority found the tool visually appealing, easy to read, and low in cognitive load; one-quarter reported mild anxiety (feeling 'somewhat nervous')

• Confidence Interval: Not reported

Clinical Application

The online delivery format is feasible for integration into pre-consultation digital health platforms, patient portals, or telehealth workflows. The gist-based approach may reduce cognitive burden for patients with lower health literacy. However, further validation in lower-literacy and non-English-speaking populations is required before broad implementation. Randomised trial evidence comparing gist-based versus traditional decision aids on informed decision-making outcomes is needed. In Australia, prostate cancer screening with PSA is not part of a national organised program; the RACGP and Cancer Council Australia recommend shared decision-making conversations for men aged 50–69 years (or 40–69 years for high-risk men), making decision aids directly relevant to general practice. Breast cancer screening is delivered through BreastScreen Australia for women aged 40–74 years, with active recruitment targeting 50–74 years. Gist-based decision aids could complement BreastScreen Australia's informed consent processes and support GPs in PSA counselling. The TGA does not regulate decision aids as therapeutic goods, but RACGP guidelines emphasise patient-centred communication tools. The Cancer Australia framework for consumer involvement in cancer decision-making aligns with the participatory development approach used in this study. Equity considerations are particularly relevant given Australia's Indigenous populations, who face disproportionate barriers to cancer screening and may benefit from simplified gist-based communication. Men aged 40–60 years considering prostate-specific antigen (PSA)-based prostate cancer screening and women aged 40–49 years considering mammographic breast cancer screening — populations facing genuine clinical equipoise and shared decision-making requirements

Abstract

BACKGROUND: Traditional approaches to designing decision aids have focused on providing completeness of information and quantitative detail. An alternative approach based on psychological research emphasises understanding the essence or 'gist' of the decision. Few gist-based decision aids exist. The objective of this study was to develop novel gist-based decision aids for prostate and breast cancer screening and evaluate their acceptability. METHODS: Men aged 40-60 years and women aged 40-49 years eligible for prostate or breast cancer screening were recruited from ResearchMatch (National Institutes of Health) and a public hospital located in New York City. Three rounds of semistructured interviews were performed to determine self-reported comprehensibility and acceptability, with iterative modifications after each phase, including: Phase 1: initial feedback; Phase 2, Round 1: evaluating our modifications; and Phase 2, Round 2: confirming final content. RESULTS: A total of 80 participants were involved in the two-phase qualitative interview process; Phase 1 and Phase 2 included 32 and 48 participants, respectively. Racial distribution was 50% white, 30% black and 10% Asian; 9% of participants were Hispanic or Latino. Most participants were highly educated. Interview themes established content validity of the final decision aids. In a quantitative analysis of the final decision aids using a questionnaire with fixed response options, acceptability was high, with two-thirds finding the length and amount of information of the decision aid to be optimal. The majority found the decision aid visually appealing, easy to read and easy to get through, and indicated that it held their interest and did not require much mental effort to read. One-quarter said the tool made them feel somewhat nervous, and three-quarters not at all. Most participants could understand and relate to the images, graphs and patient stories in the decision aid. After Phase 2, 45 of the 48 participants (94%) said they would find the decision aid helpful when making a decision. CONCLUSION: This study describes the iterative development and pilot testing of a novel gist-based decision aid for cancer screening, demonstrating high acceptability. Our findings provide a foundation for randomised trials comparing gist-based and traditional tools.

References

1. 1.Nalavenkata, S., Bergengren, O., Lynch, K., Emard, N., Austria, M., Martin, S., Ogbennaya, G., Dualeh, K., Stevanovic, K., Patel, M. I., Gonsky, J., Vickers, A., Fagerlin, A., Hamilton, J. G., Hay, J. L., & Carlsson, S. (2026). Development and acceptability of gist-based decision aids for prostate and breast cancer screening: a two-phase qualitative interview study in an online setting. BMJ Open. https://doi.org/10.1136/bmjopen-2024-095951