Theoretical Foundations for Interventions Designed to Promote Informed Decision Making for Cancer Screening Deborah J. Bowen, Ph.D. Fred Hutchinson Cancer Research Center and University of Washington, School of Public Health Jennifer D. Allen, Ph.D. Dana-Farber Cancer Institute Thuy Vu Fred Hutchinson Cancer Research Center and University of Washington, School of Public Health Robin E. Johnson Mount Holyoke College Kelly Fryer-Edwards, Ph.D. University of Washington, School of Medicine Alton Hart, Jr., M.D., M.P.H. Virginia Commonwealth University, Department of Internal Medicine ABSTRACT Background: Decision aids are currently being developed and evaluated for use in cancer-screening decisional settings. Purpose: The purpose of this article is to review and discuss the theoretical basis of interventions to promote informed decision making in cancer screening. Methods: We reviewed interven- tions cited in Briss et al. (1) and Rimer et al. (2) to identify their theoretical basis, intervention content, measurement strategies, and outcomes. Results: Few interventions had a strong, deci- sion-oriented conceptual basis. This was apparent in their inter- vention content, the measurement strategy, and the choice of outcomes for the study. Conclusions: We recommend that more research occur into the basis of decision making in cancer screening and that future interventions use this research to rig- orously design and evaluate decision aids to help people make choices about cancer screening. (Ann Behav Med 2006, 32(3):202–210) INTRODUCTION There is growing interest in using informed decision mak- ing (IDM) to help patients make decisions about complicated medical issues and procedures, matched by an increased desire on the part of patients for involvement in decision making (3,4). IDM is generally defined as the process that patients go through to make a decision about engaging in a medical or health-related procedure or activity, considering benefits, harms, risks, health improvements, the match between these properties and personal values and preferences, and understanding the uncertainty and limitations of the procedures. Knowledge is defined as both awareness and understanding of the possible outcomes, risks, and benefits of the procedure or choice. Preferences, or values, are ideas and beliefs held by the patient that could be used to guide the decision or choice. If the decision is to engage in or consider the procedure or activity, patients then often undergo a process of shared decision making with a provider, to make a fi- nal decision (5). IDM tools and interventions are often used for health deci- sions that have the following characteristics: There is a lack of consensus regarding best course of action, determination of the optimal strategy must be based on individualized preferences, and individual preferences for potential outcomes vary (6). De- cision aids, or interventions designed to help people make spe- cific and deliberative choices among options by providing (at a minimum) information on the options and outcomes relevant to the person’s health status (7), are often used to help patients with this process. Multiple types of decision aids have been devel- oped and evaluated to help people work through the process of IDM, including print booklets and materials and electronic tools, such as videotapes and interactive computer programs (8). The area of IDM in cancer screening and prevention is rela- tively new and needs research attention and application from other fields. A recently published chapter in the Community Guide to Preventive Services reviewed the evidence for inter- ventions to improve IDM about cancer screening (5). The re- view called for more attention to the conceptual basis for the in- tervention design, specifically more focus on patients’ values and preferences, and not simply knowledge acquisition. It con- 202 This publication was supported in part by the Centers for Disease Con- trol and Prevention and the National Cancer Institute through the Cancer Prevention and Control Research Network, a network within the CDC’s Prevention Research Centers Program (Grant 1-U48-DP- 000050). This work was also supported by Grants U48/CCU 115807-05, SIP 2-02, Component#3 (Dana Farber Cancer Institute). Reprint Address: D. J. Bowen, Ph.D., Fred Hutchinson Cancer Re- search Center, 1100 Fairview Avenue, North M3-B232, Seattle, WA 98109. E-mail: dbowen@fhcrc.org © 2006 by The Society of Behavioral Medicine. Downloaded from https://academic.oup.com/abm/article/32/3/202/4631768 by guest on 01 April 2023