Skip to main content



Rue, Montserrat (2022), DECIDO-professionals-barriers-facilitators, Dryad, Dataset,


This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. Risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, workload of health professionals and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.


We conducted an exploratory cross-sectional study with health professionals whose work was or was not directly related to breast cancer screening. Our research team contacted and presented the study to the board of directors of several Catalan and Spanish health related societies and scientific groups (public health, family and community medicine, and breast specialists). We asked them to invite the society or group members to participate in the study which consisted of responding to a questionnaire with an estimated completion time of 20 minutes. The study information and the link to the questionnaire were posted in the scientific societies' web pages or newsletters. For data protection reasons, we did not have information on the number of potential participants, or their demographic or job characteristics Therefore, a self-selection sampling method where individuals choose to take part in research on their own accord, was used.

Data were collected between July and November of 2020, using a web-based survey. The questionnaire was built on the Typeform platform ( in the Spanish and Catalan languages. A pilot test with a convenience sample of 20 participants was conducted and some changes were made based on their suggestions. 

A survey sample size of 210 professionals was chosen as appropriate so that 95% confidence intervals of the true proportion responding positively would be approximately 7% either side of the observed proportion. We closed the data collection when 220 health professionals had completed the survey.

  • Sociodemographic data: age, gender, professional field (nurse, doctor, other), medical specialty or professional profile, years of practice, type of work center (public, private, both, university, other), type of relationship or employment contract, and work relation with early detection of breast cancer (yes/no);
  • Advantages of risk-based screening for the health of women with an individual risk of breast cancer higher (6 items) /lower (6 items) than the population average;
  • Disadvantages of risk-based screening for women’s health (6 items);
  • Advantages of risk-based screening, in relation to current screening, for the Spanish National Health System (4 items);
  • Barriers (15 items) and facilitators (6 items) for the implementation of risk-based screening;
  • Implementation of shared decision-making in breast cancer screening (12 items);
  • Aspects of the organizational structure to consider for the implementation of a risk-based screening program (9 items);
  • Communication of the benefits and harms of breast cancer screening (7 items);
  • Coordination of the risk-based screening program (3 items);

Except sociodemographic data, all items were scored on 5-point Likert scales. For the first six sections of the questionnaire, related to the risk-based program, the importance given to the statements was assessed as: 1-unimportant, 2-slightly important, 3-moderately important, 4-important, and 5-very important. For the last two sections -communication of the benefits and harms and coordination of the risk-based screening program-, the level of agreement given to the statements was assessed as: 1-strongly disagree, 2-disagree, 3-undecided, 4-agree, 5-strongly agree.

In addition, the survey included these two questions:

  • Considering the advantages and disadvantages, how important is it for you to move from the current Screening Program to a personalized Breast Cancer Screening Program? Answer: 1 to 5 Likert scale, where 1-very little or nothing and 5-a lot;
  • Given the current Breast Cancer Screening Program, do you think Primary Care should be the gateway to a future personalized breast cancer screening program? Answer: Yes/No.


Instituto de Salud Carlos III, Award: PI17/00834

Santander Program scholarship 2020

European Regional Development Fund, Award: 713679

Instituto de Salud Carlos III, Award: PI18/00773