Of 15 patients who, in responding to outreach, said they were not interested in making an appointment, 8 reported that they had previously had a decision-making discussion with their PCP and did not want to complete screening.
We concluded that introducing the DA at the time of CATH was probably too late for a shared decision-making discussion to occur.
Based on USPSTF guidelines, these patients should (ideally) have engaged in a decision-making discussion before completing screening, which should have been documented in the EHR.
While evidence-based medicine proponents promote a shared decision-making discussion of the tradeoffs between harms and benefits in screening test decisions, the public dialogue may be overtaken by proscreening advocates who treat screening as a mandate, not a choice.
A recent study [ 37] suggests an interaction between the GP's use of CPI and patients' use of publicly available CPI in the decision-making discussion about referral with their GPs.
The initial question was: " Could you please tell me in an anonymous manner, about the time(s) when you experienced conflict during an end-of-life decision-making discussion with a substitute decision-maker of a dying patient?" The first author conducted each semi-structured interview in person.
