Informed decision-making and colorectal cancer screening: is it occurring in primary care?

Med Care. 2008 Sep;46(9 Suppl 1):S23-9. doi: 10.1097/MLR.0b013e31817dc496.


Background: Current recommendations advise patients to participate in the decision-making for selecting a colorectal cancer (CRC) screening option. The degree to which providers communicate the information necessary to prepare patients for participation in this process is not known.

Objective: To assess the level of informed decision-making occurring during actual patient-provider communications on CRC screening and test for the association between informed decision-making and screening behavior.

Research design: Observational study of audiotaped clinic visits between patients and their providers in the primary care clinic at a Veterans Administration Medical Center.

Subjects: Male patients, age 50-74 years, presenting to a primary care visit at the study site.

Measures: The Informed Decision-Making (IDM) Model was used to code the audiotapes for 9 elements of communication that should occur to prepare patients for participation in decision-making. The primary outcome is completion of CRC screening during the study period.

Results: The analytic cohort consisted of 91 patients due for CRC screening who had a test ordered at the visit. Six of the 9 IDM elements occurred in < or =20% of the visits with none addressed in > or =50%. CRC screening occurred less frequently for those discussing "pros and cons" (12% vs. 46%, P = 0.01) and "patient preferences" (6% vs. 47%, P = 0.001) compared with those who did not.

Conclusions: We found that a lack of informed decision-making occurred during CRC screening discussions and that particular elements of the process were negatively associated with screening. Further research is needed to better understand the effects of informed decision-making on screening behavior.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / psychology
  • Communication
  • Decision Making*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Mass Screening / methods
  • Mass Screening / psychology*
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Education as Topic
  • Pennsylvania
  • Physician-Patient Relations*
  • Primary Health Care