Primary Care Physicians’ Support of Shared Decision Making for Different Cancer Screening Decisions

Abstract

Background Despite widespread advocacy, shared decision making (SDM) is not routinely used for cancer screening. To better understand implementation barriers, we describe primary care physicians’ (PCPs’) support for SDM across diverse cancer screening contexts. Methods Mailed survey administered to random sample of US-based PCPs. Using multivariable logistic regression we tested association of PCPs’ SDM support with US Preventive Service Task Force (USPSTF) assigned recommendation grade, whether decision pertained to not screening elders, and PCP’s autonomous vs. controlled motivation-orientation for using SDM. Results PCPs (N=278) were on average aged 52 years, 38% female, and 69% white. 79% endorsed discussing screening benefits as very important to SDM, compared to 64% for discussing risks and 31% for agreeing with patient’s opinion. PCPs were most likely to rate SDM as very important for colorectal cancer (CRC) screening in adults aged 50–75 years (69%), and least likely for CRC screening in adults aged >85 years (34%). Regression results indicated importance of PCPs’ having autonomous or self-determined reasons for engaging in SDM (e.g., believing in benefits of SDM) (OR=2.29, 95% CI 1.87, 2.79). PCPs’ support for SDM varied by USPSTF recommendation grade (overall contrast, chi-square=14.7, p=0.0054), with support greatest for A-grade recommendations. Support for SDM was lower in contexts where decision pertained to not screening elders (OR=0.45, 95% CI 0.35, 0.56). Limitations Unknown whether PCP’s perception of importance of SDM behaviors differed by specific screening decision and potential limited ability to generalize findings. Conclusions Results highlight need to document SDM benefits and consider specific contextual challenges, such as the level of uncertainty or whether evidence supports recommending/not recommending screening, when implementing SDM across an array of cancer screening contexts.

“They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

“…By fulfilling the role of decision coaches (Stacey et al, 2012; Stacey et al, 2008), nurses prepare individuals to have conversations with their practitioners about screening decisions (Grad et al, 2017; Lang et al, 2018; RNAO, 2015; Stacey et al, 2008). However, providers also face organizational barriers such as performance quality metrics that might impede shared decision-making (Elston Lafata et al, 2017; Walter & Lewis, 2007). …”

“…Shared decision making provides an opportunity to implement evidence-based practice that accounts for patient preferences, such that when multiple options are available to patients regarding a specific health decision, individuals’ personal characteristics and values will influence the best choice for them (Hoffmann et al, 2014; Stacey et al, 2017). However, the use of shared decision making in cancer screening is seldom used and such approaches that have been used are diverse (Elston Lafata, Brown, Pignone, Ratliff, & Shay, 2017; Hoffmann et al, 2014). …”

Development and field testing of a tool to elicit women's preferences among cervical cancer screening modalities

“…By providing recent evidence on the cervical screening modalities that are available, women who use this tool can compare the current options independently, prior to a clinical encounter. With a balanced, nondirective design, women might feel more confident to ask for their preferred option in an encounter with a provider, particularly if their preference diverges from the provider's preference …”

“…With a balanced, nondirective design, women might feel more confident to ask for their preferred option in an encounter with a provider, particularly if their preference diverges from the provider's preference. [52][53][54] Beyond the individual level, we used a shared decision-making framework to develop an approach that can be used to elicit preferences among a population-based sample. Some experts are wary of applying population preferences in individual encounters for cancer screening because extrapolating might be inaccurate or ignore individual's autonomy in decision-making.…”

Decision making about Pap test use among Korean immigrant women: A qualitative study

“…Studies of shared decision‐making in breast, colorectal and prostate cancer screening revealed that patient/provider communications are often ineffective . Elston Lafata et al .…”