Men's Use of an Internet-Based Decision Aid for Prostate Cancer Screening

Abstract

Most medical organizations recommend informed decision making before undergoing prostate cancer screening. The authors conducted a detailed evaluation of men's use of an interactive, Web-based prostate cancer screening decision aid. Participants (N = 531) were 57 years old (SD = 6.8), 37% were African American, and 92% had Internet access. Men completed 2 telephone interviews, pre- and 1-month post-Web site availability. Half of the sample (n = 256) accessed the Web site. Multivariate analysis revealed that users were more likely than nonusers to be White (OR = 2.37, CI 1.6-3.6), previously screened (OR = 2.13, CI 1.07-4.26), have Internet access (OR = 3.66, CI 1.15-11.58), and to report daily Internet use (OR = 2.58, CI 1.47-4.55). Agreement between self-reported and actual Web site use was moderate (κ = .67). Tracking software revealed a mean of 1.3 (SD = 0.5) log-ons and a median of 38 min per log-on. Of participants, 84% used the values clarification tool, and more than 50% viewed each video testimonial. Baseline screening preference was associated with values clarification tool responses and Web site feedback. This study revealed that, beyond the digital divide, Web site use depended on more than Internet access. Further, electronic tracking of Web site use demonstrated overestimation of self-reported use, high use of interactive features, and effect of baseline screening preference on men's response to the Web site.

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

“…In a prior analysis of our PCa screening website [29], we presented the number of unique logins, total and average time spent on particular sections of the website, use of video testimonials, and the characteristics of website users vs. nonusers. Men responded favorably to the website, spending a median of 34 min on the website, and over 88 % of users responded to all 10 values clarification items [29].…”

“…Men responded favorably to the website, spending a median of 34 min on the website, and over 88 % of users responded to all 10 values clarification items [29]. In the current study, we assessed the degree to which our web-based decision aid impacted important decision-making outcomes.…”

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

“…The primary study limitation was the necessary reliance on participants' self-reported use of the decision aids. In the web arm, we compared the self-report data with the results from the tracking software and found some overestimation of decision aid use, 19 suggesting the possibility that both arms may have overestimated their use of the decision tools. However, we are unaware of any reason to expect that the degree of overestimation would differ between groups.…”

“…More information about the decision aids is available. 18,19 Measures Descriptive Variables. We assessed demographics (age, race, education level, employment, income, whether men had a regular physician, insurance, and numeracy 20 ) and clinical characteristics (comorbidities, personal history of cancer, family history of prostate cancer, prostate cancer screening history in one's lifetime and in the year prior to trial enrollment), and recollection of a prior discussion of prostate cancer screening with a physician.…”

“…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 ). At the 13-month interview, we assessed men's self-reported use of the materials and patient-physician communication since the one-month follow-up.…”