Richard M Hoffman1, Joann G Elmore2, Michael P Pignone3, Bethany S Gerstein4, Carrie A Levin4, Kathleen M Fairfield5. 1. Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States; Medicine Service, Iowa City VA Medical Center, Iowa City, IA, United States. 2. Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States. 3. University of North Carolina Division of General Internal Medicine, Chapel Hill, NC, United States; University of North Carolina Institute for Healthcare Quality Improvement, Chapel Hill, NC, United States. 4. Informed Medical Decisions Foundation, Division of Healthwise, Inc. Boston, MA, United States. 5. Department of Medicine and Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States. Electronic address: fairfk@mmc.org.
Abstract
BACKGROUND: Guidelines recommend shared decision making (SDM) for cancer screening decisions. SDM requires providers to ensure that patients are informed about screening issues and to support decisions that are concordant with patient values. We evaluated decision-quality factors for breast, colorectal, and prostate cancer screening decisions. METHODS: We conducted a national, population-based Internet survey of adults aged 40+ to characterize perceptions about about cancer screening, the importance of information sources, cancer screening knowledge, values and preferences for screening, and the most influential drivers of decisions. RESULTS: Among 1452 participants who completed the survey, the mean age was 60, and 94% were insured. Most participants reported feeling well informed about cancer screening, though only 21% reported feeling extremely well informed. Most participants correctly answered about 50% of the knowledge questions, with the majority markedly overestimating lifetime risk of cancer diagnoses and mortality. Participants rated health care providers as the most important source of information. CONCLUSION: Although respondents considered themselves well informed about cancer they performed poorly on knowledge questions. This discordance suggests the potential for poor-quality decision making. PRACTICE IMPLICATIONS: To improve the quality of decision making, providers need training to utilize decision support tools and time to carry out SDM.
BACKGROUND: Guidelines recommend shared decision making (SDM) for cancer screening decisions. SDM requires providers to ensure that patients are informed about screening issues and to support decisions that are concordant with patient values. We evaluated decision-quality factors for breast, colorectal, and prostate cancer screening decisions. METHODS: We conducted a national, population-based Internet survey of adults aged 40+ to characterize perceptions about about cancer screening, the importance of information sources, cancer screening knowledge, values and preferences for screening, and the most influential drivers of decisions. RESULTS: Among 1452 participants who completed the survey, the mean age was 60, and 94% were insured. Most participants reported feeling well informed about cancer screening, though only 21% reported feeling extremely well informed. Most participants correctly answered about 50% of the knowledge questions, with the majority markedly overestimating lifetime risk of cancer diagnoses and mortality. Participants rated health care providers as the most important source of information. CONCLUSION: Although respondents considered themselves well informed about cancer they performed poorly on knowledge questions. This discordance suggests the potential for poor-quality decision making. PRACTICE IMPLICATIONS: To improve the quality of decision making, providers need training to utilize decision support tools and time to carry out SDM.
Authors: Rachel A Freedman; Nancy L Keating; Lydia E Pace; Joyce Lii; Ellen P McCarthy; Mara A Schonberg Journal: J Clin Oncol Date: 2017-07-27 Impact factor: 44.544