Fostering informed decisions: A randomized controlled trial assessing the impact of a decision aid among men registered to undergo mass screening for prostate cancer

Abstract

Objective Screening asymptomatic men for prostate cancer is controversial and informed decision making is recommended. Within two prostate cancer screening programs, we evaluated the impact of a print-based decision aid (DA) on decision-making outcomes. Methods Men (N=543) were 54.9 (SD=8.1) years old and 61% were African-American. The 2 (booklet type: DA vs. usual care (UC)) × 2 (delivery mode: Home vs. Clinic) randomized controlled trial assessed decisional and screening outcomes at baseline, two-months, and 13-months. Results Intention-to-treat linear regression analyses using generalized estimating equations revealed that DA participants reported improved knowledge relative to UC (B=.41, p<.05). For decisional conflict, per-protocol analyses revealed a group by time interaction (B = −.69, p<.05), indicating that DA participants were less likely to report decisional conflict at two-months compared to UC participants (OR=.49, 95% CI: .26–.91, p<.05). Conclusion This is the first randomized trial to evaluate a DA in the context of free mass screening, a challenging setting in which to make an informed decision. The DA was highly utilized by participants, improved knowledge and reduced decisional conflict. Practice implications These results are valuable in understanding ways to improve the decisions of men who seek screening and can be easily implemented within many settings.

Baseline Attitudes About Prostate Cancer Screening Moderate the Impact of Decision Aids on Screening Rates

“…Several randomized controlled trials have evaluated decision aids for prostate cancer screening, typically among primary care patients. Findings have been mixed regarding the impact of decision aids on men’s screening rates, with some studies finding reduced screening [7], no change [8,9], or increased screening [10]. …”

A Comparison of Web-Based Versus Print-Based Decision Aids for Prostate Cancer Screening: Participants’ Evaluation and Utilization

“…Second, 65 % of the sample understood that the materials were not recommending either for or against screening, which is an increase in understanding from previous decision aid studies. 12,14,16 Third, men were significantly more likely to use the print-based compared to the web-based decision aid. However, we also found evidence that use of the decision aid was impacted by receiving one's preferred decision aid medium: in multivariable models, use of the web-based decision aid was significantly greater among those who preferred web-based materials, while use of the print-based decision aid was not associated with a preference for print materials.…”

“…At baseline, telephone interviewers assessed men's preference for print-based versus web-based health information, and Internet access and use. We used a series of questions to assess patients' evaluation of decision aids from our prior work assessing other decision aids 16,18 and incorporated other studies' prostate cancer screening decision aid evaluations. 11,12 At the one-month interview, we assessed self-reported use of the materials, ratings of the content, patient-physician communication about the materials, and reasons for not using the materials (see Kassan et al for web use based on electronic tracking data 19 ).…”

“…10 Previous trials of decision aids for prostate cancer screening have reported very favorable participant ratings of decision aid clarity and helpfulness. [11][12][13][14][15][16] Decision aid content was typically rated as neutral (i.e., neither encouraging nor discouraging screening) compared to usual care. [11][12][13]16 Although these studies evaluated patient responses to decision aids, we are aware of no study that has assessed the potential influence of demographic and clinical variables on the likelihood of using and understanding the materials.…”

Patient and Physician Factors Associated with Undisclosed Prostate Cancer Screening in a Sample of Predominantly Immigrant Black Men

“…Patient-focused interventions promoting informed decision making among black men in the U.S. have been effective at increasing knowledge about prostate cancer testing, increasing communication between patients and physicians, and reducing decision conflict related to testing [31, 43–45]. However, such interventions do not prevent physicians from engaging in undisclosed opportunistic testing.…”