A decision theory perspective on why women do or do not decide to have cancer screening: systematic review

J Adv Nurs. 2009 Jun;65(6):1130-40. doi: 10.1111/j.1365-2648.2009.04981.x. Epub 2009 Apr 3.


Aim: This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening.

Background: Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence.

Data sources: Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria.

Methods: Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing.

Findings: All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo.

Conclusion: Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Decision Making*
  • Decision Theory*
  • Fear
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Mammography / psychology
  • Mass Screening / psychology*
  • Sweden
  • United Kingdom
  • United States
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears / psychology