Inconsistencies in patient perceptions and observer ratings of shared decision making: The case of colorectal cancer screening

Tracy Wunderlich, Gregory Cooper, George Divine, Susan Flocke, Nancy Oja-Tebbe, Kurt Stange, Jennifer Elston Lafata

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Objective: To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions. Methods: Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations. Results: 70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication. Conclusion: Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening. Practice implications: Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions.

Original languageEnglish (US)
Pages (from-to)358-363
Number of pages6
JournalPatient Education and Counseling
Issue number3
StatePublished - Sep 2010
Externally publishedYes


  • Colorectal cancer
  • Observer report
  • Patient report
  • Relational communication
  • Shared decision making

ASJC Scopus subject areas

  • Medicine(all)


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