Dataset Information

Trends in Use of Risk-Reducing Mastectomy in a Context of Celebrity Decisions and Media Coverage: An Observational Study in the United States and Australia.

ABSTRACT: OBJECTIVE:To examine trends in risk-reducing mastectomy (RRM) and immediate breast reconstruction in New York State and New South Wales, especially before and after Angelina Jolie's announcement of her surgery in 2013. DATA SOURCE:Hospital discharge data, 2004-2014. STUDY DESIGN:Trends in procedures were assessed using Poisson regression and the Cochrane-Armitage test. DATA EXTRACTION METHODS:Extracted using procedure codes. PRINCIPAL FINDINGS:There was an increase in RRM procedures after May 2013 in both regions, with a peak during late 2013-early 2014. The average bimonthly RRM procedures were significantly higher after Jolie's announcement than before. CONCLUSIONS:In both countries, we found a substantial increase of RRM after Jolie's announcement, highlighting the impact of celebrity health care coverage on preventive surgical choice and the need for decision aids to assist patients.

SUBMITTER: Mao J

PROVIDER: S-EPMC6056602 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Trends in Use of Risk-Reducing Mastectomy in a Context of Celebrity Decisions and Media Coverage: An Observational Study in the United States and Australia.

Mao Jialin J Jorm Louisa L Sedrakyan Art A

Health services research 20170925

<h4>Objective</h4>To examine trends in risk-reducing mastectomy (RRM) and immediate breast reconstruction in New York State and New South Wales, especially before and after Angelina Jolie's announcement of her surgery in 2013.<h4>Data source</h4>Hospital discharge data, 2004-2014.<h4>Study design</h4>Trends in procedures were assessed using Poisson regression and the Cochrane-Armitage test.<h4>Data extraction methods</h4>Extracted using procedure codes.<h4>Principal findings</h4>There was an inc ...[more]

PMID: 28944955

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Project description:BackgroundSmartphone apps are increasingly used for health-related behaviour change and people discover apps through different sources. However, it is unclear whether users differ by mode of app discovery. Drink Less is an alcohol reduction app that received national media coverage in the UK caused by celebrity influence (a male TV and radio national broadcaster, aged 51). Our aim was to compare users who discovered the app before and after this coverage.MethodsA natural experiment assessing the impact of media coverage of Drink Less on users' socio-demographic and drinking characteristics, app engagement levels, and extent of alcohol reduction. The study period was from 17th May 2017 to 23rd January 2019, with media coverage starting on 21st August 2018. Users were 18 years or over, based in the UK and interested in drinking less. Interrupted time series analyses using Generalised Additive Mixed Models were conducted for each outcome variable aggregated at the weekly level.ResultsIn 66 weeks prior to the media coverage, 8617 users downloaded the app and 18,959 in 23 weeks afterwards. There was a significant step-level increase in users' mean age (B = 8.17, p < .001) and a decrease in the percentage of female users (B = -27.71, p < .001), though these effects dissipated non-linearly over time. No effect of media coverage was detected on employment type or on the percentage of at-risk drinkers, though the mean Alcohol Use Disorders Identification Test score was lower after the media coverage (B = -1.43, p = .031). There was a step-level increase in app engagement - number of sessions (B = 3.45, p = .038) and number of days used (B = 2.30, p = .005) - which continued to increase over time following quadratic trends.ConclusionsCelebrity influence leading to national media coverage in the UK of the Drink Less app was associated with more people downloading the app who were male, older and engaged with the app; and did not appear to impact employment inequality.

Project description:ImportanceBreast reconstruction has the potential to improve a person's body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions.ObjectiveTo assess the quality of patient decisions about breast reconstruction.Design, setting, and participantsA prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis.ExposuresMastectomy only and mastectomy with reconstruction.Main outcome and measuresKnowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance.ResultsDuring the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00-7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35-1.93; P < .001), having a high school education or less (vs some college) (OR, 4.84; 95% CI, 1.22-19.21; P = .02), having a college degree (vs some college) (OR, 1.95; 95% CI, 1.53-2.49; P < .001), and not having a malignant neoplasm (eg, BRCA carriers) (OR, 3.13; 95% CI, 1.25-7.85; P = .01) were independently associated with making a high-quality decision.Conclusions and relevanceA minority of patients undergoing mastectomy in a single academic center made a high-quality decision about reconstruction. Shared decision making is needed to support decisions about breast reconstruction.

Project description:Evidence suggests that suicide rates can increase following the suicide of a prominent celebrity or peer, sometimes known as 'suicide contagion'. The risk of contagion is especially high when media coverage is detailed and sensational. A recent study reported a 10% increase in U.S. suicides in the months following the suicide of comedian Robin Williams, who died in August 2014. The authors tentatively linked this increase to sensational media coverage; however, no content analysis of U.S. media was performed. As such, the aim of the present study is to formally examine the tone and content of U.S. newspaper coverage of Williams' suicide. The primary objective is to assess adherence to suicide reporting guidelines in U.S. newspapers after his suicide. The secondary objective is to identify common emerging themes discussed in these articles. The tertiary objective is to compare patterns of results in the U.S media with those in the Canadian media. Articles about Williams' suicide were collected from 10 U.S. newspapers in the 30-day period following his death using systematic retrieval software, which were then examined for adherence to suicide reporting recommendations. An inductive thematic analysis was also undertaken. A total of 63 articles were included in the study. We found that 100% of articles did not call it a 'successful' suicide, 96.8% did not use pejorative phrases and 71% did not say 'commit' suicide. However, only 11% included information about help-seeking, 27% tended to romanticize his suicide and 46% went into detail about the method. The most prominent emerging theme was Williams' struggles with mental illness and addiction. These findings suggest that U.S. newspapers moderately adhered to best practice recommendations when reporting Williams' suicide. Key recommendations were underapplied, which may have contributed to suicide contagion. New interventions targeting U.S. journalists and media may be needed to improve suicide reporting.

Project description:Objective To examine the effect on BRCA testing and mastectomy rates of a widely viewed 2013 New York Times editorial by public figure Angelina Jolie that endorsed BRCA testing and announced Jolie's decision to undergo preventive mastectomy.Design Observational study with difference-in-difference analysis.Setting Commercially insured US population.Participants Women aged 18-64 years with claims in the Truven MarketScan commercial claims database (n=9 532 836).Main outcome measures Changes in BRCA testing rates in the 15 business days before versus after 14 May 2013 (editorial date) compared with the change in the same period in 2012; mastectomy rates in the months before and after publication, both overall and within 60 days of BRCA testing among women who were tested; national estimates of incremental tests and expenditures associated with Jolie's article in the 15 days after publication.Results Daily BRCA test rates increased immediately after the 2013 editorial, from 0.71 tests/100 000 women in the 15 business days before to 1.13 tests/100 000 women in the 15 business days after publication. In comparison, daily test rates were similar in the same period in 2012 (0.58/100 000 women in the 15 business days before 14 May versus 0.55/100 000 women in the 15 business days after), implying a difference-in-difference absolute daily increase of 0.45 tests/100 000 women or a 64% relative increase (P<0.001). The editorial was associated with an estimated increase of 4500 BRCA tests and $13.5m (£10.8m; €12.8) expenditure nationally among commercially insured adult women in those 15 days. Increased BRCA testing rates were sustained throughout 2013. Overall mastectomy rates remained unchanged in the months after publication, but 60 day mastectomy rates among women who had a BRCA test fell from 10% in the months before publication to 7% in the months after publication, suggesting that women who underwent tests as a result of to the editorial had a lower pre-test probability of having the BRCA mutation than women tested before the editorial.Conclusions Celebrity endorsements can have a large and immediate effect on use of health services. Such announcements can be a low cost means of reaching a broad audience quickly, but they may not effectively target the subpopulations that are most at risk for the relevant underlying condition.

Dataset Information

Trends in Use of Risk-Reducing Mastectomy in a Context of Celebrity Decisions and Media Coverage: An Observational Study in the United States and Australia.

Publications

Trends in Use of Risk-Reducing Mastectomy in a Context of Celebrity Decisions and Media Coverage: An Observational Study in the United States and Australia.

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