Informed decision-making and colorectal cancer screening: is it occurring in primary care? Med Care 2008 Sep;46(9 Suppl 1):S23-9
Date
09/09/2008Pubmed ID
18725829DOI
10.1097/MLR.0b013e31817dc496Scopus ID
2-s2.0-52449122026 (requires institutional sign-in at Scopus site) 67 CitationsAbstract
BACKGROUND: Current recommendations advise patients to participate in the decision-making for selecting a colorectal cancer (CRC) screening option. The degree to which providers communicate the information necessary to prepare patients for participation in this process is not known.
OBJECTIVE: To assess the level of informed decision-making occurring during actual patient-provider communications on CRC screening and test for the association between informed decision-making and screening behavior.
RESEARCH DESIGN: Observational study of audiotaped clinic visits between patients and their providers in the primary care clinic at a Veterans Administration Medical Center.
SUBJECTS: Male patients, age 50-74 years, presenting to a primary care visit at the study site.
MEASURES: The Informed Decision-Making (IDM) Model was used to code the audiotapes for 9 elements of communication that should occur to prepare patients for participation in decision-making. The primary outcome is completion of CRC screening during the study period.
RESULTS: The analytic cohort consisted of 91 patients due for CRC screening who had a test ordered at the visit. Six of the 9 IDM elements occurred in < or =20% of the visits with none addressed in > or =50%. CRC screening occurred less frequently for those discussing "pros and cons" (12% vs. 46%, P = 0.01) and "patient preferences" (6% vs. 47%, P = 0.001) compared with those who did not.
CONCLUSIONS: We found that a lack of informed decision-making occurred during CRC screening discussions and that particular elements of the process were negatively associated with screening. Further research is needed to better understand the effects of informed decision-making on screening behavior.
Author List
Ling BS, Trauth JM, Fine MJ, Mor MK, Resnick A, Braddock CH, Bereknyei S, Weissfeld JL, Schoen RE, Ricci EM, Whittle JAuthor
Jeffrey Whittle MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedColorectal Neoplasms
Communication
Decision Making
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Mass Screening
Middle Aged
Patient Acceptance of Health Care
Patient Education as Topic
Pennsylvania
Physician-Patient Relations
Primary Health Care
