Lack of Shared Decision Making in Cancer Screening Discussions

Hoffman, Richard M.; Elmore, Joanne G.; Fairfield, Kathleen M.; Gerstein, Bethany S.; Levin, Carrie A.; Pignone, Michael

doi:10.1016/j.amepre.2014.04.011

Cited by 71 publications

(56 citation statements)

References 35 publications

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“…Unfortunately, efforts have focused on oncologists and a few preventive medicine residency programs with specific curricula for a cancer prevention and control track [26]. Our results support the previous report concerning the need for curricular changes to expand the scope of cultural competency and health disparity education to cancer-related decision-making topics such as prevention, screening, and survivorship [27][28][29]. Primary care physicians in training must acquire an in-depth understanding of the main issues related to cancer care disparities.…”

Section: Discussionsupporting

confidence: 93%

Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice

et al. 2015

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Workforce development initiatives designed to mitigate cancer health disparities focus primarily on oncologists rather than on primary care providers (PCPs) who could be better positioned to address the issue at the preventive and community levels. The purpose of this project was to assess primary care resident physicians' self-perceived attitudes and comfort level in addressing cancer health disparities. Resident physicians in their first- through third-year of training in family, internal, preventive/occupational medicine, and obstetrics and gynecology (OB/GYN) at three academic centers responded to a 13-question survey in the spring of 2013. Descriptive and chi-square statistics were performed to analyze responses to (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. A total of 78 (70.9 %) residents responded to the survey. Twenty three (29.5 %) of the respondents felt they did not understand the socio-demographic characteristics of their patients' communities, and 20 (25.6 %) did not feel capable of discussing current cancer-related care guidelines when the patients' personal beliefs conflict with their own. Few of the relationships between residency program and location with outcome measures met the criteria for statistical significance. Family medicine residents were the most likely to report in that it was hard to interact with persons from other cultures. As PCPs will play a key role in addressing cancer health disparities, effective educational opportunities in cancer care by primary care residents are warranted.

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Section: Discussionsupporting

confidence: 93%

Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice

et al. 2015

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“…Discussions about the risks and benefits of other cancer screening tests have proved to be challenging, with many patients not fully understanding the limitations of screening. 15 Distortions of logic, specious rationalizations, and cognitive dissonance related to health outcomes and tobacco use is common among smokers, especially heavily addicted, 16 long-term smokers who are the target group for screening. 17,18 The Veterans Health Administration (VHA) Lung Cancer Screening Clinical Demonstration Project is one of the first efforts to implement screening in routine practice using a systemwide clinical reminder, similar to prompts for breast and colorectal cancer screening.…”

Section: Resultsmentioning

confidence: 99%

Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening

et al. 2015

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Broad adoption of lung cancer screening may inadvertently lead to negative population health outcomes if it is perceived as a substitute for smoking cessation.OBJECTIVE To understand views on smoking cessation from current smokers in the context of being offered lung cancer screening as a routine service in primary care. DESIGN, SETTING, AND PARTICIPANTSAs an ancillary study to the launch of a lung cancer screening program at 7 sites in the Veterans Health Administration, 45 in-depth semi-structured qualitative interviews about health beliefs related to smoking and lung cancer screening were administered from May 29 to September 22, 2014, by telephone to 37 current smokers offered lung cancer screening by their primary care physician. Analysis was conducted from June 15, 2014, to March 29, 2015. MAIN OUTCOMES AND MEASURESAttitudes and perceptions about the importance of smoking cessation in the context of lung cancer screening.RESULTS Lung cancer screening prompted most current smokers to reflect for the first time on what smoking means for their current and future health. However, 17 of 35 (49%) participants described mechanisms whereby screening lowered their motivation for cessation, including the perception that undergoing an imaging test yields the same health benefits as smoking cessation. Other misperceptions include the belief that everyone who participates in screening will benefit; the belief that screening and being able to return for additional screening offers protection from lung cancer; the perception by some individuals that findings from screenings have saved their lives by catching their cancer early when indeterminate findings are identified that can be monitored rather than immediately treated; and a reinforced belief in some individuals that a cancer-free screening test result indicates that they are among the lucky ones who will avoid the harms of smoking. CONCLUSIONS AND RELEVANCEIn this qualitative, lung cancer screening prompted many current smokers to reflect on their health and may serve as a potential opportunity to engage patients in discussions about smoking cessation. However, several concerning pathways were identified in which screening, when offered as part of routine care and described as having proven efficacy, may negatively influence smoking cessation. Health care professionals should be aware that the opportunity for early detection of lung cancer may be interpreted as a way of avoiding the harms of smoking. To promote cessation, discussions should focus on the emotional response to screening rather than clinical details (eg, nodule size) and address misperceptions about the value of early detection so that screening does not lower motivation to quit smoking.

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“…SDM has proved itself as an approach to addressing these vast areas of uncertainty, but there is still a worrying reluctance to put it into practice [48]. Are we still struggling to change our ideas about patient obedience nearly 150 years after the Canadian Medical Association published its Code of Ethics?…”

Section: Eliciting Values and Preferencesmentioning

confidence: 99%

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

Blair

2015

Patient

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The idea of shared decision making (SDM) between patient and physician grew out of a generalized challenge to traditional social hierarchies that occurred in the middle of the last century. Governments have espoused SDM, thousands of articles about it have been published, and evidence has shown that it improves some of the healthcare processes as well as patient outcomes. Yet it has not been widely adopted. From their cross-disciplinary perspective (practical theology and clinical medicine), the authors locate this reluctance in the unfolding of scientific paradigm shifts, summarize the perceived risks and benefits of SDM and the evidence for each, and suggest practical, achievable approaches for clinicians. Finally, they explore some important emerging territories for SDM. Key Points for Decision MakersShared decision making (SDM) has proved its worth and is achievable … but debates continue.Several validated models are available right now for use in clinical practice.People can and are being successfully trained in SDM.SDM is needed to address emerging value-laden clinical decisions such as those about caring for the elderly and about genetic testing.

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Lack of Shared Decision Making in Cancer Screening Discussions

Cited by 71 publications

References 35 publications

Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice

Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice

Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

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