Informed Decision-Making to Promote Cancer Screening

• IDM interventions
  • contain evidence-based, balanced, understandable, appropriate, and succinct information on disease and the potential intervention
  • encourage individuals to participate in values clarification and decision making consistent with their preferences
  • include, but are not limited to, “decision aids” that are designed to help people make specific and deliberate choices (that may include not having a screening), and
  • can be delivered
    • through available channels including mass media, group education or one-on-one education, or
    • to community members outside of healthcare systems (and do not need to include providers).
• IDM complements and supports shared decision making that takes place in a clinical setting, but they are different processes.
  • Shared decision making is a process in which both the patient and clinician share information, participate in the decision-making process, and agree on a course of action.
  • IDM can occur when someone considers information about preventive services from sources such as the Internet, without benefit of a consultation from a clinician.
  • Shared decision making is described fully in a report from a working group of the U.S. Preventive Services Task Force.

Findings from the Systematic Review

• Though IDM interventions may be in use now or in the past, the evidence for their effectiveness was considered insufficient because the results of how well they work and for whom has not be reported in enough places.
• Eleven studies met the criteria for inclusion in the systematic review, representing 15 comparisons that included: 10 for prostate cancer screening, three for colorectal screening, and two for mammography.
• While there was generally consistent evidence that IDM interventions improved knowledge, accuracy of beliefs, risk perceptions, or a combination of these, there was little or no evidence about whether these interventions:
  • result in individuals participating in decision making at a level they desire
  • result in decisions that are consistent with individual values and preferences, or
  • affect screening rates, especially among high-risk populations (e.g. older, non-white, and low-income).
• Further research is needed to determine if IDM interventions meet their stated goals and increase screening rates. In addition, more information on the presence and magnitude of barriers to and harms of IDM interventions is needed.

Suggestions for Research

• Determine the effect of IDM interventions on outcomes other than knowledge, beliefs, and perceptions of risk.
• Conduct studies that look at the impact of IDM interventions on individuals’ participation in decision making and whether this participation is at a level they desire.
• Develop methods to assess patient preferences in clinical settings and to ensure that their decisions are consistent with their preferences and values.
• Conduct research on cost and cost effectiveness or cost utility of IDM interventions.
• Assess the impact of IDM among non-white, older, and underserved populations.
• Determine if IDM or shared decision making increases or decreases use of effective services.

• Screening tests for breast, cervical and colorectal cancer are effective ways to detect cancer at early stages when treatment is likely to work best.
• There have not been enough studies conducted to determine if screening for lung, ovarian, prostate, and skin cancers can reduce deaths from those cancers.
• Strategies to improve informed decision making (IDM) around screening for cancer and other health risks are increasingly important as many people want to be involved in decisions about their health care. However:
  • much of the science related to cancer screening is complicated and difficult to communicate in a short office visit
  • some information is not accurate or user-friendly, and
  • many people at high risk don’t have access to regular health care and must make screening decisions on their own.

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Informed decision making to promote cancer screening. Centers for Disease Control and Prevention. www.thecommunityguide.org/cancer/screening.
Last Updated: MM/DD/YYYY.

Review completed: : January 2004