Decision-making processes for breast, colorectal, and prostate cancer screening: the DECISIONS survey.
BACKGROUND
Patients should understand the risks and benefits of cancer screening in order to make informed screening decisions.


OBJECTIVE
To evaluate the extent of informed decision making in patient-provider discussions for colorectal (CRC), breast (BrCa), and prostate (PCa) cancer screening.


METHODS
National sample of US adults identified by random-digit dialing.


METHODS
Cross-sectional survey conducted between November 2006 and May 2007.


METHODS
English-speaking US adults aged 50 y and older who had discussed cancer screening with a health care provider within the previous 2 y.


METHODS
Cancer screening survey modules that asked about demographic characteristics, cancer knowledge, the importance of various sources of information, and self-reported cancer screening decision-making processes.


RESULTS
Overall, 1082 participants completed 1 or more of the 3 cancer modules. Although participants generally considered themselves well informed about screening tests, half or more 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 and overestimated the positive predictive values of prostate-specific antigen tests and mammography. Providers were the most highly rated information source, usually initiated screening discussions (64%-84%), and often recommended screening (73%-90%). However, participants reported that providers elicited their screening preferences in only 31% (CRC women) to 57% (PCa) of discussions. Although more than 90% of the discussions addressed the pros of screening, only 19% (BrCa) to 30% (PCa) addressed the cons of screening.


CONCLUSIONS
Recall bias is possible because screening process reports were not independently validated.


CONCLUSIONS
Cancer screening decisions reported by patients who discussed screening with their health care providers consistently failed to meet criteria for being informed. Given the high ratings for provider information and frequent recommendations for screening, providers have important opportunities to ensure that informed decision making occurs for cancer screening decisions.
Hoffman
Richard M
RM
Medicine Service, New Mexico VA Health Care System and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. rhoffman@unm.edu
Lewis
Carmen L
CL
Pignone
Michael P
MP
Couper
Mick P
MP
Barry
Michael J
MJ
Elmore
Joann G
JG
Levin
Carrie A
CA
Van Hoewyk
John
J
Zikmund-Fisher
Brian J
BJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003142:Communication; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D018570:Risk Assessment; D013997:Time Factors; D014481:United States