Decision-making processes for breast, colorectal, and prostate cancer screening: The DECISIONS survey.

Hoffman, R. M., Lewis, C. L., Pignone, M. P., Couper, M. P., Barry, M. J., Elmore, J. G., …& Zikmund-Fisher, B. J., (2010). Decision-making processes for breast, colorectal, and prostate cancer screening: The DECISIONS survey. Medical Decisions Making, 30(5), 53S-64S.

Background—Patients should understand the risks and benefits of cancer screening in order to make informed screening decisions. 

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

Design—National random-digit dial telephone survey.

Subjects—English-speaking U.S. adults aged 50 and older who had discussed cancer screening with a health care provider within the previous two years. 

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

Results—Overall, 1,082 participants completed one or more of the three cancer modules. Although participants generally considered themselves well informed about screening tests, half or more could not correctly answer even one 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 PSA 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 providers elicited their screening preferences in only 31% (CRC women) to 57% (PCa) of discussions. While over 90% of the discussions addressed the pros of screening, only 19% (BrCa) to 30% (PCa) addressed the cons of screening. 

Limitations—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. 

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