Are docs having the right kinds of cancer screening discussions with patients?

Breast cancer screening and its effect on cancer mortality rates, as well as the harms associated with overdiagnosis and false positives, was in the news yet again this past week as a study in the journal BMJ showed that mammography screening can significantly cut mortality rates from the disease.

But in a commentary accompanying the article, the authors suggested that the question remains whether the benefits of mammography outweigh its harms, a question that should be the subject of a discussion between doctors and their patients, they say.  

That begs another question: Are doctors having the right kind of conversation with their patients about breast cancer screening?

According to a study published online June 8 in the American Journal of Preventive Medicine, doctor-patient discussions about the harms and benefits of screening tests don't meet ideal standards, particularly when the patient is a woman.

The authors surveyed patients who had undergone breast, colorectal and prostate cancer screening over a two-year period, and found that only a small percentage of doctors (just 7 percent to 14 percent) discussed the drawbacks of screening with their patients; only about one-third of the discussions between doctors and patients met their criteria for what is considered to be shared decision making (SDM).

The results were even worse when it came to breast screening, according to study coauthor Richard Hoffman, M.D., of the University of New Mexico School of Medicine in Albuquerque. Hoffman told Medscape Medical News that the lowest quality discussions were for mammography. Only 43 percent of women in the study recalled being asked whether they wanted mammography (compared, for example, to 70 percent of men who underwent prostate cancer screening).

Based on these numbers, doctors seriously need to alter their approach to breast cancer screening with their patients.

One of the problems seems to be broad-based in the sense that providers have been slow to adopt the idea of a shared decision making model with patients. That could be part habit, but it could also be a question of time--the time necessary for doctors to make sure they are up-to-date with all of the latest screening guidelines, as well as the time necessary to engage in meaningful discussions with their patients.

With that in mind, the researchers make the sensible suggestion that creating a billing code for shared decision making could help encourage SDM by ensuring that doctors are reimbursed for that time.

In the end, the answer to the question of whether or not a person should get screened is probably going to be yes. But that doesn't mean that doctors and patients shouldn't have the conversation. - Mike (@FierceHealthIT)

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