Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening

Patient Educ Couns. 2010 Sep;80(3):358-63. doi: 10.1016/j.pec.2010.06.034. Epub 2010 Jul 27.


Objective: To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions.

Methods: Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations.

Results: 70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication.

Conclusion: Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening.

Practice implications: Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / psychology
  • Communication*
  • Decision Making*
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Observer Variation
  • Patient Acceptance of Health Care
  • Patient Participation*
  • Physician-Patient Relations*
  • Surveys and Questionnaires