Patient education on prostate cancer screening and involvement in decision making

Abstract

Purpose: Many clinicians lack resources to engage patients in shared decision making for prostate cancer screening. We sought to evaluate whether previsit educational decision aids facilitate shared decision making.

Methods: This randomized controlled study compared a Web-based and a paper-based decision aid with no previsit education. Men aged 50 to 70 years undergoing a health maintenance examination at a large family practice were enrolled. The primary outcome was patient-reported level of control over the decision to be screened. Secondary outcomes included frequency of screening, patient knowledge, decisional conflict, and time spent discussing screening.

Results: A total of 497 men participated (75 control, 196 brochure, 226 Web site). Patients exposed to either aid were no more likely than control patients to report a collaborative decision: 36% of patients in each group reported equally sharing decision responsibility. Exposure to either decision aid increased patients' involvement in decision making compared with the control condition (Web site, P = .03; brochure, P = .03). Only 46% of control patients reported an active decision-making role, compared with 56% of Web site and 54% of brochure patients. Patients exposed to a decision aid answered a greater percentage of knowledge questions correctly (54% control vs 69% Web site, P <.001, and vs 69% brochure, P <.001) and were less likely to be screened (94% control vs 86% Web site, P = .06, and vs 85% brochure, P = .04).

Conclusions: Patients in the decision aid groups were more informed and more engaged in the screening decision than their control counterparts. Exposure did not promote shared decision-making control, however. Whether shared decision making is the ideal model and how to measure its occurrence are subjects for further research.

Figure 1.

Flowchart of study patients. Note: Numbers of patients exclused do not add up to 576 because patients could have more than 1 reason for exclusion, ie, have blood work before examination and decline.

Figure 2.

Locus of decision-making control (N = 431). Note: The figure shows patient-reported decision-making control by study group. A smaller percentage of control patients reported being in control of their decision making than did Web site patients (P₁ = .03) or brochure patients (P₂ = .03) when responding to the question, “How was the decision made today on whether to do a PSA blood test? (A) I made the decision on whether to order a PSA test. (B) I made the decision about whether to order a PSA test after seriously considering my doctor’s opinion. (C) My doctor and I shared the responsibility for deciding whether to order a PSA test. (D) My doctor made the final decision about whether to order a PSA test after seriously considering my opinion. (E) My doctor made the decision whether to order a PSA test.” Previsit education did not increase the frequency of a shared locus of decision-making control (choice C).

Figure 3.

Patients’ actual and desired locus of decision-making control (N = 431). Note: The figure shows the level of concordance between the locus of decision-making control that patients reported and the locus of control that they desired. Concordance did not differ between the 3 study groups (P₁ = .41). Participants overall were more likely to report “More patient control than desired” than “More physician control than desired,” however (19% vs 11%, P₂ = .003).