Shared decision making in preventive health care

Many thanks to the authors for providing a breakdown of the process of shared decision making in preventive health care. Having a structure to follow makes it more approachable and doable than simply suggesting this be done.

I have used the CTFPHC tools to do discuss screening tests with patients, especially for prostate cancer and lung cancer screening and for discouraging women under 50 from wanting a screening mammogram. I do find as mentioned in the article it takes patients a while to absorb the information and giving them a printout of the tool ( I often circle the number of persons harmed and numbers who benefit) to read over later is helpful with the message that they we can re-discuss at any time.

I realize there are limitations to how much you can discuss in an article such as this, but it would be helpful to make some reference to how difficult this task is and the nuances of discussing harms vs benefits. When I have presented the CTFPHC tools to my family physician and nurse practitioner colleagues , this often leaves them scratching their heads as to how to balance numbers of patients harmed by the test vs numbers of patients who benefit. So a patient with no medical training,possibly less knowledge of statistics and often a different level of education will frequently find it very difficult to understand. I will read your references on shared decision making, but I often do question myself on how much value to place on a false positive screening test causing anxiety but no serious outcome vs a death due to a complication of testing vs a life saved by testing. Obviously deaths are more serious and patients can grasp that. Some patients like to know no matter what if they have cancer and others would rather not know. But I find most are in the middle and not sure how to interpret these numbers even when they know their values and preferences.I realize there are no easy answers but presenting the difficulties in a "how to" article is helpful and could be grounds for another article, with references to researchers who have looked into this. Many thanks for plunging into this difficult domain for clinicians.