A Multi-Level Strategy for De-implementing Mammography Overuse Among Older Women
De-implementation of Overuse of Mammography Screening in Older Racially and Ethnically Diverse Women
Columbia University
500 participants
Mar 11, 2026
INTERVENTIONAL
Conditions
Summary
This project aims to advance methodological and theoretical approaches for developing, selecting, refining, and piloting a multilevel de-implementation strategy to reduce the overuse of screening mammography in women aged ≥75 years. Informed by an innovative participatory, stakeholder-driven innovation tournament and a discrete choice experiment, the research team identified, prioritized, and tailored a multilevel de-implementation strategy. The research team will conduct a cluster randomized controlled trial (at the provider level) to test the impact of the provider- and patient-level components of the multilevel strategy on screening mammography use, and secondarily, on provider referrals/orders for screening mammography. The organizational level components of the multilevel strategy will be implemented among all participants, not via random assignment.
Eligibility
Inclusion Criteria6
- Patient level criteria
- English- or Spanish-speaking women based on preferred language in electronic health record
- Aged 75 and older at the time of their scheduled primary care visit
- Women who have a primary care visit scheduled within the next 2-4 weeks
- Women who have not had a screening mammogram 6 months prior to their scheduled primary care visit but have had a screening mammogram 7-18 months prior to their scheduled primary care visit
- Primary care clinicians attributed to the 2 intervention clinics that serve adult patients, including those ≥75 years
Exclusion Criteria7
- Women with a history of atypical ductal hyperplasia (ADH) or non-invasive or invasive breast cancer (assessed via ICD 10 code)
- Women with dementia (assessed via ICD 10 code)
- Provider level criteria
- Specialists
- Primary care clinicians for patients < 18 years old
- Non-clinicians
- Physician assistants
Interested in this trial?
Get notified about updates and connect with the research team.
Interventions
Enhanced usual care entails the organizational level components of the multilevel de-implementation strategy. These organizational components have been implemented within the overarching New York City healthcare system where the 2 clinics receiving the provider and patient components are located. The organizational level components are: 1) Grand Rounds Education: providers and clinic leadership received Grand Rounds education on screening mammography overuse among older women, and 2) Task Force: a multidisciplinary task force (e.g., radiologists, breast oncologists, primary care providers, clinic leadership) have been collaborating with the research team to build consensus around guidelines for clinical practice and revisions to the screening mammography results and reminder letters sent to patients.
This multilevel de-implementation strategy includes the organizational level components that comprise enhanced usual care (described above) as well as provider and patient level components. At the provider level, the research team will disseminate educational newsletters including the latest guidelines, information, and resources on screening mammography for older women. At the patient level, the research team will disseminate a brief brochure titled the 'Rethink Resource' in which patients are activated and encouraged to speak with their providers about whether continuing to get mammograms is best for them given current guidelines.
Locations(1)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT07511621