Cancer screening decision aids fall short

Data examining the outcomes of cancer screening decision aids designed to help improve doctor-patient communication and educate patients about the pros and cons of timing, frequency and methods of breast, cervical, colon and prostate cancer screening are variable and sparse, according to a study published in the May/June issue of CA: A Cancer Journal for Clinicians.

“We continue to see more cancer screening options and also conflicting recommendations on whether to get screened, which method to use and how often it should be done,” said Masahito Jimbo, MD, PhD, MPH, associate professor in family medicine and urology at the University of Michigan Medical School in Ann Arbor, in a release.

Jimbo and colleagues sought to determine whether decision aids could improve shared decision making. They examined 73 decision aids and focused on five questions:

• Does the decision aid used in the study address the issues that need to be addressed in a screening decision aid?
• Does the study measure the effect of the decision aid on the patient attributes established in the theories of behavioral research?
• Does the study address the impact of the decision aid on the patient behavior in question?
• Does the study address the effect of the decision aid on the subsequent discussion between the patient and his/her clinician?
• Does the decision aid appear to be applicable in real-world practice?

All of the decision aids provided information about cancer and screening tests and the benefits and risks of each screening option.  

A total of 43 decision aids provided guidance on communicating with clinicians. “Intention was measured in 40 of 73 decision aids. Nine decision aids led to an increased intention to get screened; 7 of these concerned colorectal cancer screening,” wrote the researchers. A total of 36 decision aids were evaluated for subsequent screening behavior, and 18 had been assessed for their effect on shared decision making.

However, “little information was available on the feasibility and outcomes of integrating decision aids into actual practice,” according to the release. “Just over one-third of the decision aids provided explicit values clarification exercises.” While most studies assessed knowledge, the researchers found little consistency in outcomes measured and few studies focused on patient-physician communication.

“There is also some disconnect between how decision aids can help if they’re actually applied and physicians are actually using them. As we see an increased emphasis on the importance of shared decision making between patients and doctors, we need to better understand what the most valuable tools are in aiding this goal,” Jimbo et al concluded.