CONDORDANCE OF PATIENT-REPORTED DECISION MAKING PREFERENCES AND PROCESSES USED DURING PHYSICAL EXAMS

  Purpose:  The U.S. Preventive Services Task Force advocates for the use of shared decision making when making preventive service recommendations to patients.  Yet, the extent to which patients prefer shared decision making as well as the extent to which shared decision making is used in practice remains unknown. 

 

   Methods:  Study eligible physicians are general or family medicine physicians practicing in a salaried medical group in southeast Michigan.  Eligible patients are insured under an affiliated health plan, aged 50-80 years with no evidence of fecal occult blood testing (FOBT) within a year, barium enema or flexible sigmoidoscopy within 5 years, or colonoscopy within 10 years.  Eligible patients scheduling a physical exam (PE) with a participating physician are approached for study enrollment.  Patient enrollment includes completion of a pre-visit interview, audio-recording of the visit, and a post-visit survey.  Using the Degner Decision Making Preference Questionnaire (1997) we evaluate preferences for preventive health service decision making expressed by patients prior to their PE with patient post-visit self-reports of how decisions were made for preventive screening tests (including blood pressure, cholesterol, colorectal cancer, breast cancer, cervical and prostate cancer screening tests) during the PE.  Patient percentages are reported and precision of estimates is assessed taking into account clusters of patients seeing the same physician.    

 

   Results:  At the time of the pre-visit interview, 70% of patients reported preferring to make preventive health screening decisions jointly with their physician.  For each of the screening tests discussed during the exam, the majority of patients reported that the decision to use the test was shared between them and their physician (ie, patients reported a shared decision-making process >48% regardless of the screening test).  The one exception was for colorectal cancer screening decisions.  When patients were asked about how the decision to be screened for colorectal cancer was made, only 31% reported the use of a shared decision-making process with their physician. 

    Conclusion:  There is a general lack of concordance when comparing patient reported decision-making preferences with patient reports of how preventive service decisions are made in practice.  This discordance is especially true for colorectal cancer screening decisions.  Further research is needed to determine if there is an association between preventive service decision-making process concordance and adherence to evidence-based preventive health services utilization.