Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis

Abstract

Context: Although screening recommendations for prostate cancer using prostate-specific antigen testing often include shared decision making, the effect of patient decision aids on patients’ intention and uptake is unclear. This study aimed to review the effect of decision aids on men’s screening intention, screening utilization, and the congruence between intentions and uptake. Evidence acquisition: Data sources were searched until April 6, 2018, and included MEDLINE, Scopus, CENTRAL, CT.gov, Cochrane report, PsycARTICLES, PsycINFO, and reference lists. This study included RCTs and observational studies of decision aids that measured prostate screening intention or behavior. The analysis was completed in April 2018. Evidence synthesis: Eighteen studies (13 RCTs, four before–after studies, one non-RCT) reported data on screening intention for ≅8,400 men and screening uptake for 2,385 men. Compared with usual care, the use of decision aids in any format results in fewer men (aged ≥40 years) planning to undergo prostate-specific antigen testing (risk ratio=0.88, 95% CI=0.81, 0.95, p=0.006, I2=66%, p<0.001, n=8). Many men did not follow their screening intentions during the first year after using a decision aid; however, most men who were planning to undergo screening did so (probability that men who wanted to be screened would receive screening was 95%). Conclusions: Integration of decision aids in clinical practice may result in a decrease in the number of men who elect prostate-specific antigen testing, which may in turn reduce screening uptake. To ensure high congruence between intention and screening utilization, providers should not delay the shared decision-making discussion after patients use a decision aid.

Prostate Cancer-based Interventions’ Efficacy on Knowledge and Adherence Intention to Healthy Lifestyle among Men

“…The results in the current study support educational program efficacy in gaining knowledge among Jordanian men in Amman at one month after the implementation of the educational program. This finding is consistent with the findings of many studies (Drake et al, 2010;Keane, 2015;Ivlev et al, 2018). which showed that the educational program significantly improved cancer-related knowledge.…”

“…Regarding the effect of educational program efficacy on adherence intention to a healthy lifestyle, the results showed that the adherence intention to healthy lifestyle variable improved significantly after 1 month form the application of the educational program. This finding is congruent with the finding of the previous research studies (Odedina et al, 2014;Keane, 2015;Ivlev et al, 2018), which showed that educational program significantly improved the adherence intention to a healthy lifestyle. An important possible explanation for the improvement in the adherence intention to a healthy lifestyle in the present study is the significant improvement in the level of knowledge regarding prostate cancer after the application of the educational program.…”

The Effect of Prostate Cancer Educational Program on the level of Knowledge and Intention to Screen among Jordanian Men in Amman

“…Regarding the effect of the prostate cancer educational program on intention to screen, the results of the current study showed that the intention to screen variable improved significantly 1 month after the application of the educational program in the experimental group compared to the comparison group. This finding is congruent with the finding of the previous research studies (Odedina et al, 2014;Keane, 2015;Ivlev et al, 2018), The finding of this study suggests that PCS intention may be influenced by PC educational program. This explanation was supported by evidence in previous literature, which showed a statistically significant increase in intention to screen, after an educational intervention (Odedina et al, 2014;Capanna et al, 2015).…”

“…Lastly et al, (2000), compared an illustrated pamphlet to a traditional pamphlet and noticed that both increased the level of knowledge, but neither increased the real usage of PSA testing. Similarly, other investigators reported a high knowledge score about PC and PCS, among respondents, after receiving the educational intervention (Drake et al, 2010;Keane, 2015;Ivlev et al, 2018). The significant effect of the prostate cancer educational program on knowledge may be attributed to many factors.…”

Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

“…30 Decision aids could potentially improve patient knowledge prior to screening and have been used to improve knowledge for other screening programmes. [31][32][33][34] They could be used to explain the diagnostic test, conditions that could be diagnosed, quantitative information relating to diagnostic accuracy and the risks and benefits of treatment. They could also be used to promote clarification of patients' preferences about the screening and potential consequences to improve patient knowledge.…”