Being Proactive Critical in Battle Against Cancer
But Study Questions Guidance Provided to Patients
With a focus on shared decision-making between
doctors and patients, more studies needed to determine how decision aids
help guide choices for cancer screening
May 13, 2013 - When it comes to a cancer diagnosis,
timing can be everything – the sooner it’s found, the more treatable it
is. But when and how often should someone get screened? Are physicians
doing their part to help patients make wise decisions?
A growing number of educational, interactive tools
known as “decision aids” – such as videodiscs, audiotapes, workbooks and
pamphlets – are intended to supplement patient-doctor discussions on the
pros and cons of timing, methods and frequency for different types of
A University of Michigan study found that despite
strong recommendations from the medical community to use these aids to
help patients make more well-informed decisions, there is lack of
evidence on whether they work – which may lead to fewer doctors using
“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,” says lead author
Masahito Jimbo, M.D., Ph.D., M.P.H., associate professor in family
medicine and urology at the U-M Medical School.
“Our goal was to determine whether decision aids
could potentially lead to better shared decision-making regarding
screening between the patient and the clinician. There is evidence that
decision aids are fairly effective in improving patient knowledge but we
found that they may not be used as well and effectively as they could
The study appears in CA: A Cancer Journal for
Clinicians, a medical journal published for the American Cancer
Decision aids are delivered as self-administered or
practitioner administered tools designed to help patients understand the
disease, associated tests and treatments and the risks versus benefits
of different types of screening.
They are designed to help address such issues as
whether to get a stool blood test versus a colonoscopy for colon cancer
screening or whether women under the age of 50 should get screened for
breast cancer at all.
Researchers reviewed 73 decision aids for breast,
cervical, colon and prostate cancers. • Just half of the decision aids, 36, were evaluated for
subsequent screening behavior. • Only a quarter of the decision aids, 18, had been assessed
for their effect on shared decision making. • Little information was available on the feasibility and
outcomes of integrating decision aids into actual practice.
“These decision aids are designed as tools to
improve communication between patients and clinicians, so it’s
surprising that there is so little data to support claims that they
improve shared decision making,” Jimbo says.
With the push towards more sophisticated electronic
health records, decision aids may become more available to patients
looking for additional guidance on health decisions, authors note.
Certain screening options also continue to be
debated among the medical community. The U.S. Preventive Services Task
Force, for example, recommended against routine screening for prostate
cancer, while other guidelines encourage doctors and patients to weight
the risks and benefits. Decision aids may assist patients and doctors
work through those conflicting recommendations together.
“Do decision aids help improve communication
between a patient and physician and can that improved communication lead
to better outcomes – those are the broader questions we need to answer,”
“There is also some disconnect between how decision
aids can help if they’re actually applied and physicians 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.”
Notes: Additional authors included Gurpreet K. Rana,
MLIS; Sarah Hawley, Ph.D., M.P.H.; Margaret Holmes-Rovner, Ph.D.; Karen
Kelly-Blake, Ph.D.; Donald E. Nease, Jr., M.D., and Mack T. Ruffin IV,
Dr. Jimbo receives funding from the National Cancer
Institute (Grant RO1CA152413).
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