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

Abstract

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

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

Setting: National sample of US adults identified by random-digit dialing.

Design: Cross-sectional survey conducted between November 2006 and May 2007.

Participants: English-speaking US adults aged 50 y and older who had discussed cancer screening with a health care provider within the previous 2 y.

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

Results: Overall, 1082 participants completed 1 or more of the 3 cancer modules. Although participants generally considered themselves well informed about screening tests, half or more could not correctly answer even 1 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 prostate-specific antigen 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 that providers elicited their screening preferences in only 31% (CRC women) to 57% (PCa) of discussions. Although more than 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.

Figure 1

Cohort assembly. Shaded boxes indicate subjects included in this manuscript.

Figure 2

Surveillance Epidemiology End Results (SEER) registry and participant estimates for cancer incidence and mortality.