Table 2.

GRADE Summary of Findings and Quality of Evidence

Use of breast cancer screening patient decision aids compared to usual care in changing women’s intention to undergo screening mammography
Patient or population: asymptomatic women (aged 38–50, 69–89) who were not diagnosed with breast cancer prior to using a screening mammography patient decision aid Intervention: breast cancer screening patient decision aid Comparison: usual care Outcome: change in screening intention Setting: primary care, community-based
Outcomes	Anticipated absolute effects†† (95% CI)		Relative effect (95% CI)	No. of participants (studies) Follow-up	Quality of evidence (GRADE)	Comments (for evidence of moderate quality)
	Assumed effect in usual care	Corresponding effect after using a BCS-PtDA
KQ1: Reluctance to be screened for breast cancer	Women aged 38–50 and 69-71		RR 1.48 (1.04–2.13)	1869 (3 RCTs)15 , 17 , 18	⊕⊕⊕○ Moderate*	The use of BCS-PtDAs can increase the proportion of women who do not intend to be screened.
	105 per 1000	50 more per 1000 (4–118 more)
	Women aged 38–49 and 75-89		RR 1.05 (0.54–2.05)	171 (3 before–after studies)16 , 19 , 20	⊕○○○ Very low*†‡§
	105 per 1000	5 more per 1000 (48 fewer to 111 more)
KQ2a: Reluctance to be screened for breast cancer in women 38–50	Women aged 38-50		RR 1.77 (1.34–2.34)	1164 (2 RCTs)15 , 17	⊕⊕⊕○ Moderate*	It suggests that in younger women, the use of BCS-PtDAs increased the proportion of women who did not intend to be screened.
	111 per 1000	85 more per 1000 (38–149 more)
	Women aged 38-49		RR 0.80 (0.39–1.64)	126 (2 before–after studies)16 , 20	⊕○○○ Very low*†‡§
	119 per 1000	24 fewer per 1000 (73 fewer to 76 more)
KQ2b: Reluctance to be screened for breast cancer in women 69–71 and 75-89	Women aged 69-71		RR 1.02 (0.64–1.61)	705 (1 RCT)18	⊕⊕○○ Low*§¶
	93 per 1000	2 more per 1000 (33 fewer to 57 more)
	Women aged 75-89		RR 2.33 (0.64–8.46)	45 (1 before–after study)19	⊕○○○ Very low*†§||#
	67 per 1000	89 more per 1000 (24 fewer to 497 more)

†† The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)⁴⁴

GRADE Working Group grades of evidence

Moderate quality: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low quality: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimated effect

Very low quality: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimated effect

* Downgraded because of a low number of events and low optimal information size (imprecision)^† Outcomes of interest were not measured multiple times before the intervention and multiple times after the intervention (risk of bias)^‡ Participants in both studies are not representative of those who would be eligible for the intervention in the general population (risk of bias)

^§ Studies show imprecise effect (imprecision)

^¶ Unknown risk of performance bias: blinding of participants and personnel (risk of bias)

^|| The sample size was not sufficiently large to provide confidence in the findings (risk of bias)

^# Large effect