Shared Decision-making in breast cancer screening programmesContributions to its implementations

Abstract

As the awareness of patients as users of the national health system increases, they demand more well-being, which is not only related to solving their problem, but also a good accompaniment by health professionals. That is, feeling heard, receiving understandable information, being treated with empathy, and getting involved in decisions that affect your health seem to be important elements to consider. This has been understood by the different health systems, which have declared patients as the center of the model, although it is sometimes a challenge to put it into routine practice. Shared Decision-making (SDM) could be an alternative for more participatory and patient-centered care, as well as “The Three-talk” model would simplify its application in specific health or disease situations. In this context, women in breast cancer screening have a low involvement in the decision to participate, since they do not have a space in which to express their fears, doubts, or preferences to a health professional, and do not have sufficient information on the benefits and adverse effects of participating in screening. Even worse, they do not see these deficiencies as a necessity, since the benefit of early detection is very much internalized as the only possible result and they do not know or minimize the adverse effects they may suffer due to screening: false positives, false negatives or overdiagnosis. This thesis aims to contribute to the development of a more participatory health in the context of breast cancer screening in a context of the National Health System, using the SDM model. Three studies were carried out: 1) to know the barriers and facilitators for the application of the SDM from the perspective of health professionals, 2) create two documents, manual and guide, to give practical support to health professionals to involve women in the screening decision, 3) to know the preferences of women by comparing the attributes of the conventional health model and one with the incorporation of an SDM.