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Primary Care Physicians' Support of Shared Decision Making for Different Cancer Screening Decisions
Jennifer Elston Lafata1, Richard F Brown1, Michael P Pignone2
1Massey Cancer Center and Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA (JEL, RFB).
Summary
Primary care physicians (PCPs) support shared decision-making (SDM) for cancer screening, but this support varies by screening context and is influenced by autonomous motivation. Understanding these factors is key for effective SDM implementation.
Area of Science:
- Oncology
- Primary Care Medicine
- Health Services Research
Background:
- Shared decision-making (SDM) is advocated but not routinely implemented in cancer screening.
- Barriers to SDM implementation in cancer screening require further investigation.
Purpose of the Study:
- To describe primary care physicians' (PCPs') support for SDM in various cancer screening scenarios.
- To identify factors influencing PCP support for SDM in cancer screening.
Main Methods:
- A survey was distributed to a random sample of US-based PCPs.
- Multivariable logistic regression analyzed associations between PCP support for SDM and screening context (USPSTF grade, age of patient), and PCP motivation.
Main Results:
- PCPs highly valued discussing screening benefits (79%) and risks (64%), but less so agreeing with patient opinions (31%).
- Support for SDM was strongest for colorectal cancer screening in adults aged 50-75 and for USPSTF A-grade recommendations.
- Autonomous motivation for SDM (OR = 2.29) increased support, while decisions not to screen older patients decreased support (OR = 0.45).
Conclusions:
- PCPs' support for SDM in cancer screening is context-dependent, influenced by recommendation strength and patient age.
- Autonomous motivation is a significant factor in PCP engagement with SDM.
- Implementation of SDM requires addressing contextual challenges and clearly documenting its benefits.
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