title: Promoting informed decisions about cancer screening in communities and healthcare systems.
abstract: Individuals are increasingly involved in decisions about their health care. Shared decision making (SDM), an intervention in the clinical setting in which patients and providers collaborate in decision making, is an important approach for informing patients and involving them in their health care. However, SDM cannot bear the entire burden for informing and involving individuals. Population-oriented interventions to promote informed decision making (IDM) should also be explored. This review provides a conceptual background for population-oriented interventions to promote informed decisions (IDM interventions), followed by a systematic review of studies of IDM interventions to promote cancer screening. This review specifically asked whether IDM interventions (1) promote understanding of cancer screening, (2) facilitate participation in decision making about cancer screening at a level that is comfortable for individuals; or (3) encourage individuals to make cancer-screening decisions that are consistent with their preferences and values.Fifteen intervention arms met the intervention definition. They used small media, counseling, small-group education, provider-oriented strategies, or combinations of these to promote IDM. The interventions were generally consistent in improving individuals' knowledge about the disease, accuracy of risk perceptions, or knowledge and beliefs about the pros and cons of screening and treatment options. However, few studies evaluated whether these interventions resulted in individuals participating in decision making at a desirable level, or whether they led to decisions that were consistent with individuals' values and preferences. More research is needed on how best to promote and facilitate individuals' participation in health care. Work is especially needed on how to facilitate participation at a level desired by individuals, how to promote decisions by patients that are consistent with their preferences and values, how to perform effective and cost-effective IDM interventions for healthcare systems and providers and in community settings (outside of clinical settings), and how to implement these interventions in diverse populations (such as populations that are older, nonwhite, or disadvantaged). Finally, work is needed on the presence and magnitude of barriers to and harms of IDM interventions and how they might be avoided.
authors.affiliation: Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. pbriss@cdc.gov
authors.forename: Peter
authors.initials: P
authors.lastname: Briss
authors.forename: Barbara
authors.initials: B
authors.lastname: Rimer
authors.forename: Barbara
authors.initials: B
authors.lastname: Reilley
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Coates
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Lee
authors.forename: Patricia
authors.initials: P
authors.lastname: Mullen
authors.forename: Phaedra
authors.initials: P
authors.lastname: Corso
authors.forename: Angela B
authors.initials: AB
authors.lastname: Hutchinson
authors.forename: Robert
authors.initials: R
authors.lastname: Hiatt
authors.forename: Jon
authors.initials: J
authors.lastname: Kerner
authors.forename: Prethibha
authors.initials: P
authors.lastname: George
authors.forename: Cornelia
authors.initials: C
authors.lastname: White
authors.forename: Nisha
authors.initials: N
authors.lastname: Gandhi
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
authors.forename: Rosalind
authors.initials: R
authors.lastname: Breslow
authors.forename: George
authors.initials: G
authors.lastname: Isham
authors.forename: Steven M
authors.initials: SM
authors.lastname: Teutsch
authors.forename: Alan R
authors.initials: AR
authors.lastname: Hinman
authors.forename: Robert
authors.initials: R
authors.lastname: Lawrence
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003657:Decision Making; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D007258:Informed Consent; D008403:Mass Screening; D009369:Neoplasms / Q000175:diagnosis*; D014481:United States