Lack of shared decision making in cancer screening discussions: results from a national survey

Am J Prev Med. 2014 Sep;47(3):251-9. doi: 10.1016/j.amepre.2014.04.011. Epub 2014 Jun 9.


Background: Clinicians are encouraged to support patients in achieving shared decision making (SDM) for cancer screening.

Purpose: To describe decision making processes and outcomes for cancer screening discussions.

Methods: A 2011 national Internet survey of adults aged ≥50 years who made cancer screening decisions (breast, BrCa; colorectal, CRC; prostate, PCa) within the previous 2 years was conducted. Participants were asked about their perceived cancer risk; how informed they felt about cancer tests; whether their healthcare provider addressed pros/cons of testing, presented the option of no testing, and elicited their input; whether they were tested; and their confidence in the screening decision. Data were analyzed in 2013-2014 with descriptive statistics and logistic regression.

Results: Overall, 1,134 participants (477 men, 657 women) aged ≥50 years made cancer screening decisions, and 1,098 (354, BrCa; 598, CRC; 146, PCa) decisions were discussed with a healthcare provider. Most discussions (51%-67%) addressed pros of screening some or a lot, but few (7%-14%) similarly addressed cons. For all cancer screening decisions, providers usually (63%-71%) explained that testing was optional, but less often asked women (43%-57%) than men (70%-71%) whether they wanted testing. Only 27%-38% of participants reported SDM, 69%-93% underwent screening, and 55%-76% would definitely make the same decision again. Perceived high/average cancer risk and feeling highly informed were associated with confidence in the screening decision.

Conclusions: Discussions often failed to provide balanced information and meet SDM criteria. Supporting SDM could potentially improve the quality of cancer screening decisions.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Breast Neoplasms / diagnosis*
  • Colorectal Neoplasms / diagnosis*
  • Decision Making*
  • Early Detection of Cancer / methods
  • Female
  • Health Surveys
  • Humans
  • Internet
  • Logistic Models
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Professional-Patient Relations
  • Prostatic Neoplasms / diagnosis*
  • Risk
  • Sex Factors