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Decision making in cancer primary prevention and chemoprevention

Background:We know very little about how individuals decide to undertake, maintain, or discontinue cancer primary prevention or chemoprevention.Purpose: The aims of this article are to (a) examine whether and, if so, how traditional health behavior change models are relevant for decision making in this area; (b) review the application of decision aids to forming specific, personal choices between options; and (c) identify the challenges of evaluating these decision processes to suggest areas for future research.Methods: Theoretical models and frameworks derived from the health behavior change and decision-making fields were applied to cancer primary prevention choices. Decision aids for the human papillomavirus (HPV) vaccine, Hormone Replacement Therapy (HRT), and tamoxifen were systematically examined.Results: Traditional concepts such as decisional balance and cues to action are relevant to understanding cancer primary prevention choices; Motivational Interviewing, Self-Determination Theory, and the Preventive Health Model may also explain the facilitators of decision making. There are no well-tested HPV vaccine decision aids, although there have been some studies on aids for HPV testing. There are several effective decision aids for HRT and tamoxifen; evidence-based decision aid components have also been identified.Conclusions: Additional theory-based empirical research on decision making in cancer primary prevention and chemoprevention, particularly at the interface of psychology and behavioral economics, is suggested. We thank Dr. Karen Glanz for her contributions to the literature review for this article and her coleadership of one of the break-out sessions.We also thank an anonymousAnnals of Behavioral Medicine reviewer for suggestions to the text that enriched this article.