Table 2.

Factors contributing to the need for improved teaching in preventive health care

FACTOR	CONCEPTS FOR TEACHING
Evolving understanding of the harms and benefits of screening	There is a trade-off between benefits and harms A better understanding of concepts, such as overdiagnosis and the natural history of disease, related to screening decision making is needed
Multiplicity of guideline recommendations on screening	Guidelines can have conflicting recommendations on screening for the same condition
Rise of social media and online sources of health care information on screening	Patients have many sources of information that can be biased or misleading Consider the media reliance of the survivor^21,27
More rigorous methods for evaluating the quality of evidence	Use GRADE: Grading of Recommendations Assessment, Development and Evaluation²⁸
New tools to evaluate guideline trustworthiness and quality	Use G-TRUST: Guideline Trustworthiness, Relevance, and Utility Scoring Tool²⁹
Need for effective communication with patients on the potential harms and benefits of screening	Use natural frequencies to foster insight Use knowledge translation tools in decision making with patients Recognize and employ shared decision making in clinical situations where there are trade-offs between harms and benefits
Evolution of strong patient advocacy groups on screening	Understand how belief systems influence clinical decision making
Need to understand the complex, adaptive nature of primary care	Screening decisions can be influenced by factors including patient values and preferences Different patients with similar issues will make different screening choices