Monday, June 5, 2017

Making informed decisions about cancer screening

- Jennifer Middleton, MD, MPH

Debate within the medical community regarding when and how to screen for breast cancer, prostate cancer, and colorectal cancer continues. Helping patients make informed decisions about how they wish to participate in these screenings can be a challenge for busy family physicians. Two recent articles address this challenge by providing several solutions to help us help our patients make informed decisions.

The first article is a report of a large cohort study based in Virginia that examined patients' use of an online decision module regarding breast, prostate, and/or colon cancer screening. Patients were invited to view the module if they were overdue for consideration of these screenings (women aged 40-49 without a mammogram in the last 2 years, men aged 55-69 who had not had prostate cancer screening in the last 2 years, and men and women identified as overdue for colorectal cancer screening). Uptake was low; about 20% of the 11,000+ eligible patients began a module, and only 7.9% completed a module. Of that 7.9%, though, about half felt that it enabled them to have a more helpful conversation with their physician.

The second is a review of shared decision making techniques and resources in the current issue of Family Practice Management. The article reviews clinical circumstances when shared decision making is relevant and also reminds readers that shared decision making is an integral part of the United States Preventive Services Task Force's (USPSTF's) recommendations on breast cancer screening for women aged 40-49 and lung cancer screening. It describes the 6 general steps of shared decision making along with 3 tools for using shared decision making with patients: SHARE, the 5 As, and IAIS. The article also includes a table with online resource aids for patients; the first,, provides neat graphics that may make concepts like "prevalence" and "false positive" easier to discuss using lay language.

You can read about these and other controversies in the AFP Department Collection on Editorials: Controversies in Family Medicine that also includes a search engine. You can also read more about cancer screening, diagnosis, and treatment in the AFP By Topic on Cancer.

What shared decision making techniques and/or tools have you found useful?