title: Lack of shared decision making in cancer screening discussions: results from a national survey.
abstract: BACKGROUND
  Clinicians are encouraged to support patients in achieving shared decision making (SDM) for cancer screening.
  
  
  OBJECTIVE
  To describe decision making processes and outcomes for cancer screening discussions.
  
  
  METHODS
  A 2011 national Internet survey of adults aged ≥50 years who made cancer screening decisions (breast, BrCa; colorectal, CRC; prostate, PCa) within the previous 2 years was conducted. Participants were asked about their perceived cancer risk; how informed they felt about cancer tests; whether their healthcare provider addressed pros/cons of testing, presented the option of no testing, and elicited their input; whether they were tested; and their confidence in the screening decision. Data were analyzed in 2013-2014 with descriptive statistics and logistic regression.
  
  
  RESULTS
  Overall, 1,134 participants (477 men, 657 women) aged ≥50 years made cancer screening decisions, and 1,098 (354, BrCa; 598, CRC; 146, PCa) decisions were discussed with a healthcare provider. Most discussions (51%-67%) addressed pros of screening some or a lot, but few (7%-14%) similarly addressed cons. For all cancer screening decisions, providers usually (63%-71%) explained that testing was optional, but less often asked women (43%-57%) than men (70%-71%) whether they wanted testing. Only 27%-38% of participants reported SDM, 69%-93% underwent screening, and 55%-76% would definitely make the same decision again. Perceived high/average cancer risk and feeling highly informed were associated with confidence in the screening decision.
  
  
  CONCLUSIONS
  Discussions often failed to provide balanced information and meet SDM criteria. Supporting SDM could potentially improve the quality of cancer screening decisions.
authors.affiliation: Department of Medicine, University of New Mexico School of Medicine and Medicine Service, Medicine Service, New Mexico Health Care System, Albuquerque, New Mexico. Electronic address: rhoffman@unm.edu.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.affiliation: Department of Medicine and Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Fairfield
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts.
authors.forename: Bethany S
authors.initials: BS
authors.lastname: Gerstein
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Levin
authors.affiliation: University of North Carolina Division of General Internal Medicine and the University of North Carolina Institute for Healthcare Quality Improvement, Chapel Hill, North Carolina.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006306:Health Surveys; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011369:Professional-Patient Relations; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012306:Risk; D012737:Sex Factors