Promoting informed decisions about cancer screening in communities and healthcare systems

Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 02/2004; 26(1):67-80. DOI: 10.1016/j.amepre.2003.09.012
Source: PubMed


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.

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    • "Patient preference clarification does not mean merely offering choices without guidance: when the information and options are not provided within the context of their preferences and values, patients’ ability to make a decision may actually decrease [24-28]. Clinicians are encouraged to incorporate patient values when discussing CRCS and eliciting their screening choice, counselling patients to choose the CRCS test most congruous with their preferences and values [11,23,29]. Shared decision making (SDM) recognizes the central role of the patient-clinician relationship in helping patients make such decisions [29,30]. "
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    ABSTRACT: Clinicians face challenges in promoting colorectal cancer screening due to multiple competing demands. A decision aid that clarifies patient preferences and improves decision quality can aid shared decision making and be effective at increasing colorectal cancer screening rates. However, exactly how such an intervention improves shared decision making is unclear. This study, funded by the National Cancer Institute, seeks to provide detailed understanding of how an interactive decision aid that elicits patient's risks and preferences impacts patient-clinician communication and shared decision making, and ultimately colorectal cancer screening adherence.Methods/design: This is a two-armed single-blinded randomized controlled trial with the target of 300 patients per arm. The setting is eleven community and three academic primary care practices in Metro Detroit. Patients are men and women aged between 50 and 75 years who are not up to date on colorectal cancer screening. ColoDATES Web (intervention arm), a decision aid that incorporates interactive personal risk assessment and preference clarification tools, is compared to a non-interactive website that matches ColoDATES Web in content but does not contain interactive tools (control arm). Primary outcomes are patient uptake of colorectal cancer screening; patient decision quality (knowledge, preference clarification, intent); clinician's degree of shared decision making; and patient-clinician concordance in the screening test chosen. Secondary outcome incorporates a Structural Equation Modeling approach to understand the mechanism of the causal pathway and test the validity of the proposed conceptual model based on Theory of Planned Behavior. Clinicians and those performing the analysis are blinded to arms. The central hypothesis is that ColoDATES Web will improve colorectal cancer screening adherence through improvement in patient behavioral factors, shared decision making between the patient and the clinician, and concordance between the patient's and clinician's preferred colorectal cancer screening test. The results of this study will be among the first to examine the effect of a real-time preference assessment exercise on colorectal cancer screening and mediators, and, in doing so, will shed light on the patient-clinician communication and shared decision making 'black box' that currently exists between the delivery of decision aids to patients and subsequent patient behavior.Trial Registration: ID NCT01514786.
    Full-text · Article · Nov 2013 · Trials
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    • "Shared decision-making can be defined as a joint process of decision-making between care professionals and patients (Brock, 1991; Briss et al., 2004). This concept is based on a relationship between the health and social care professional and the patient, such that the health and social care professional helps the patient understand the various options available for the proposed care/treatment (including the pros and cons of each option); makes recommendations to the patient; and helps the patient base their preference on the best evidence available (Briss et al., 2004). This process occurs with reference to what is of value to the patient. "

    Full-text · Article · Jul 2013 · International Psychogeriatrics
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    • "An informed decision occurs when a person makes a decision that is consistent with their testing preferences, values, and understanding (Briss et al., 2004). Previous studies have focused on whether decisions made about CRC screening are congruent with a patient's preference, perceived value, and understanding of CRC screening (Leard, Savides, & Ganiats, 1997; Ling, Moskowitz, Wachs, Pearson, & Schroy, 2001; Wolf & Schorling, 2000). "
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    ABSTRACT: To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women. Descriptive, cross-sectional. A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States. A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older. Participants completed a self-administered survey. Cultural identity, CRC beliefs, family support, and informed decision. Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women. Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs. To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.
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