What is lacking in current decision aids on cancer screening?

open access

 Introduction

In recent years, screening strategies for many conditions have become increasingly complex. Guidelines now recommend more options for cancer screening. Some guidelines also have conflicting recommendations. Thus, patients, with their clinicians' support, must decide whether to get screened, which modality to choose, and how often to undergo screening. These considerations are foundational to informing patients' preferences, and make these decisions “preference-sensitive.” Decision aids could be an ideal tool to help patients understand their risk of developing a particular cancer, the screening options available (including the possible option of not getting screened), recommended screening time intervals, and their own values and preferences for a particular option and outcome. Consequently, decision aids have proliferated in recent years. They usually include information on the disease/condition and the associated tests/treatments, probabilities of outcomes (benefits and harms) for each test/treatment option, and some form of a values clarification exercise to help patients determine which option would best match their values. Decision aids may also include guidance or coaching in the process of decision-making.1 They are not meant to replace the discussion between the patient and his/her clinician, but rather to complement it...........

Suggestions for Future Research

• 1
  A strong theoretical framework should support the decision aid and guide its development as well as measurement outcomes. There should be a clear correlation between the theoretical framework and the measured outcomes.
• 2
  There should be more studies that critically compare explicit versus implicit values clarification.
• 3
  An objective measure of screening uptake (eg, paper chart review, extraction of electronic health record data) should be adopted to assess the effectiveness of the decision aid.
• 4
  Shared decision-making between the patient and the clinician should be recorded and objectively measured by validated tools.
• 5
  Other potential mediators that temporally occur after the patient's decision aid use, such as media and family influence, should be considered.
• 6
  How decision aids would fare as a meaningful part of primary care practice should be assessed through their better integration into practice and a broader, practice-based approach to measure their effectiveness.
• 7
  To address applicability in real-world settings, studies should continue to be performed in heterogeneous community practice settings, using practice-based research networks.
• 8
  Long-term effectiveness and viability should be addressed, including the effect on repeated screening and cost-effectiveness and cost-benefit analyses.
• 9
  With the advent of more options in breast and cervical cancer screening and the need for even better informed and shared decision-making in prostate cancer screening with the advent of conflicting guidelines, there are even more opportunities for decision aids to be useful in the setting of cancer screening.

Conclusions

Decision aids are here to stay. Although much research needs to be done to determine what really makes for an effective decision aid, practical applications are already occurring. Many decision aids are now available free of charge. Clinicians are encouraged to explore them, select those that fit best with their current understanding of the topic in question, and apply them to their practice workflow in a creative way.