Introduction
Engaging patients to make informed choices is paramount but difficult in busy practices.
This study sought to engage patients outside the clinical setting to better understand
how they approach cancer screening decisions, including their primary concerns and
their preferences for finalizing their decision.
Methods
Twelve primary care practices offering patients an online personal health record invited
eligible patients to complete a 17-item online interactive module. Among 11,458 registered
users, invitations to complete the module were sent to adults aged 50–74 years who
were overdue for colorectal cancer screening and to women aged 40–49 years and men
aged 55–69 who had not undergone a recent mammogram or prostate-specific antigen test,
respectively.
Results
The module was started by 2,355 patients and completed by 903 patients. Most respondents
(76.8%) knew they were eligible for screening. Preferred next steps were talking to
the clinician (76.6%), reading/research (28.6%), and consulting trusted friends/family
(16.4%). Priority topics included how much screening improves life expectancy, comparative
test performance, and the prevalence/health risks of the cancer. Leading fears were
getting cancer/delayed detection (79.2%), abnormal results (40.5%), and testing complications
(39.1%), the last referring to false test results, medical complications, or unnecessary
treatments. Men eligible for prostate-specific antigen screening were more likely
than women eligible for mammography to express concerns about testing complications
and to prioritize weighing pros and cons over gut feelings (p<0.05).
Conclusions
Although this sample was predisposed to screening, most patients wanted help in finalizing
their decision. Many wanted to weigh the pros and cons and expressed fears of potential
harms from screening. Understanding how patients approach decisions may help design
more effective engagement strategies.
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Article Info
Publication History
Published online: December 11, 2017
Identification
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© 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
