The development of a web- and a print-based decision aid for prostate cancer screening

Abstract

BackgroundWhether early detection and treatment of prostate cancer (PCa) will reduce disease-related mortality remains uncertain. As a result, tools are needed to facilitate informed decision making. While there have been several decision aids (DAs) developed and tested, very few have included an exercise to help men clarify their values and preferences about PCa screening. Further, only one DA has utilized an interactive web-based format, which allows for an expansion and customization of the material. We describe the development of two DAs, a booklet and an interactive website, each with a values clarification component and designed for use in diverse settings.MethodsWe conducted two feasibility studies to assess men's (45-70 years) Internet access and their willingness to use a web- vs. a print-based tool. The booklet was adapted from two previous versions evaluated in randomized controlled trials (RCTs) and the website was created to closely match the content of the revised booklet. Usability testing was conducted to obtain feedback regarding draft versions of the materials. The tools were also reviewed by a plain language expert and the interdisciplinary research team. Feedback on the content and presentation led to iterative modifications of the tools.ResultsThe feasibility studies confirmed that the Internet was a viable medium, as the majority of men used a computer, had access to the Internet, and Internet use increased over time. Feedback from the usability testing on the length, presentation, and content of the materials was incorporated into the final versions of the booklet and website. Both the feasibility studies and the usability testing highlighted the need to address men's informed decision making regarding screening.ConclusionsInformed decision making for PCa screening is crucial at present and may be important for some time, particularly if a definitive recommendation either for or against screening does not emerge from ongoing prostate cancer screening trials. We have detailed our efforts at developing print- and web-based DAs to assist men in determining how to best meet their PCa screening preferences. Following completion of our ongoing RCT designed to test these materials, our goal will be to develop a dissemination project for the more effective tool.Trial RegistrationNCT00623090

Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid

“…Similar issues have been reported in previous research on informed choice in screening 16 27 29 30. This underscores the need for screening decision aids to start by clearly explaining their purpose and why there is a decision to make, as ours did.…”

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

“…Description of the website A detailed description of the development and content of the website has been described previously [35]. Briefly, the website was created in accordance with the International Patient Decision Aid Standard criteria [36] by providing balanced information about the risks and benefits of screening, showing a range of potential experiences with PCa screening, providing a means for patients to express their values, and using the most up-to-date literature.…”

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

“…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.…”

“…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 ).…”