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Cancer screening and “informed” patient decision making

Posted Nov 03 2010 12:00am

What people know at the time they make decisions about having tests for risk of specific cancers is important if they are to be able to make truly informed decisions about the value of these tests. That becomes even more important when we consider the pros and cons of annual, mass, population-based cancer screening tests.

The DECISIONS survey study was designed to evaluate the extent of informed decision making in patient-provider discussions prior to screening for colorectal, breast, and prostate cancers between November 2006 and May 2007. In this survey, the participants, all of whom were English-speaking Americans of 50 years or older, were asked to compete survey modules that asked about demographic characteristics, cancer knowledge, the importance of various sources of information, and self-reported cancer screening decision-making processes. All participants had to have had a discussion about cancer screening with a health care provider within the immediately preceding 2 years.

The results of the DECISIONS study, as reported by Hoffman et al. , showed the following:

  • 1,082 participants completed 1 or more of the 3 cancer modules.
  • Participants generally considered themselves to be well informed about the cancer screening tests. However, …
  • ≥ 50 percent of the participants could not correctly answer even 1 open-ended knowledge question for any given module.
  • Participants consistently overestimated risks for being diagnosed with and dying from each cancer.
  • Participants consistently overestimated the positive predictive values of PSA tests and mammography.
  • Providers were the most highly rated source of information about the tests, had usually initiated screening discussions (64-84 percent), and had often recommended screening (73-90 percent).
  • According to the participants, however,

The authors conclude that decisions about cancer screening (including decisions about screening for prostate cancer) reported by patients who had already discussed screening with their health care providers consistently failed to meet criteria for being “informed.” It would appear that (to date) providers have important opportunities to ensure that informed decision making occurs for cancer screening decisions, but that they are not yet willing or able to take appropriate advantage of those opportunities.

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