Discussions of cancer screening: What do physicians say, what do patients hear, and how much shared decision making occurs?

180 Background: Like other medical interventions, cancer screening requires shared decision-making (SDM). To better understand the process, we are performing a cluster-randomized trial of educational supports to improve screening guideline compliance for breast, cervical, colorectal, lung and prostate cancer at two urban academic medical centers. We present interim results that focus on recalled SDM discussions.

METHODS: We are enrolling an age- and sex-stratified sample of 216 patients aged 30 to 89 years, 18 treated by each of 12 primary care physicians at two affiliated hospitals before a periodic physical examination. Screening guideline format (color-coding) and academic detailing are independently assigned to providers. Patients and providers are surveyed immediately after the encounter to document SDM discussions, recommendations and beliefs. Screening guidelines (recommended, not or controversial) were determined by age, sex and risk factors.

RESULTS: The first 107 eligible enrolled patients were racially diverse (non-Hispanic Caucasian 65%) and well educated (college grad 84%). Patient-physician disagreement about whether screening had been discussed ranged from 6% (mammogram) to 36% (cervical cancer) and disagreement about whether the screening test had been recommended ranged from 17% (mammography) to 44% (PSA). In only 24 (12%) of 159 jointly recalled screening discussions did both patients and physicians agree that all 3 elements of SDM - reasons for screening, reasons against and that it is optional - were discussed, although patients and physicians separately reported all elements in 58 (36%) and 45 (28%), respectively.

CONCLUSIONS: Even immediately after the encounter, many patients and physicians recalled whether screening had been discussed and recommendations differently, and most SDM discussions were incomplete.

CLINICAL TRIAL INFORMATION: NCT02430948.