Psychosocial Predictors of Shared Decision Making Among US Cancer Survivors

Cancer survivors, who have unique health care needs, are projected to number nearly 19 million by 2025, over 5% of the US population. Shared decision making (SDM) between patients and providers is vital for patient-centered care. This study evaluated whether demographic, socioeconomic, behavioral, geographic, health, health information, and psychosocial factors predict the risk of cancer survivors not engaging in SDM.

Data from the Health Information National Trends Survey (HINTS) from 2012 to 2024 were used. Participants included adults diagnosed with cancer within the past 20 years who had one or more health care visits in the past year. SDM was measured on a four-point scale by a question about involvement in health care decisions, with dichotomization (always v usually/sometimes/never) aligned with Healthy People 2030 objectives. Forty-two variables were analyzed, and a risk prediction model was developed using 60% of the participants and validated with the remaining 40%.

The study included 3,622 participants, predominantly older than 65 years (61.5%), with 54.8% being women and 12.9% Black. A model with four variables (distrust of health care providers, distrust of family, anxiety/depression, and fair/poor perceived health) was associated with lower SDM engagement in the training set and was confirmed in the validation set. For each increase in the quartile level of adverse risks, there was a 23% reduction in the odds of SDM. The odds of experiencing SDM were 56% lower for those with 3-4 risk factors than for those with 0 risk factors.

These findings suggest that screening for psychosocial vulnerability may help identify cancer survivors who could benefit from targeted strategies to support SDM in clinical care.