A decision theory perspective on why women do or do not decide to have cancer screening: systematic review
Article first published online: 3 APR 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Advanced Nursing
Volume 65, Issue 6, pages 1130–1140, June 2009
How to Cite
Ackerson, K. and Preston, S. D. (2009), A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Journal of Advanced Nursing, 65: 1130–1140. doi: 10.1111/j.1365-2648.2009.04981.x
- Issue published online: 22 APR 2009
- Article first published online: 3 APR 2009
- Accepted for publication 22 January 2009
- breast cancer screening;
- cervical cancer screening;
- decision theory;
- systematic review;
Title. A decision theory perspective on why women do or do not decide to have cancer screening: systematic review.
Aim. This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening.
Background. Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women’s choices to improve adherence.
Data sources. Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria.
Methods. Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing.
Findings. All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo.
Conclusion. Nurses need to address proactively women’s perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits.