Helping men make an informed decision about prostate cancer screening: a pilot study of telephone counseling

Abstract

Objective: Evaluate a computer-assisted telephone counseling (CATC) decision aid for men considering a prostate specific antigen (PSA) test.

Methods: Eligible men were invited by their primary care providers (PCPs) to participate. Those consenting received an educational booklet followed by CATC. The counselor assessed stage of readiness, reviewed booklet information, corrected knowledge deficits and helped with a values clarification exercise. The materials presented advantages and disadvantages of being screened and did not advocate for testing or for not testing. Outcome measures included changes in stage, decisional conflict, decisional satisfaction, perceived vulnerability and congruence of a PSA testing decision with a pros/cons score. Baseline and final surveys were administered by telephone.

Results: There was an increase in PSA knowledge (p<0.001), and in decisional satisfaction (p<0.001), a decrease in decisional conflict (p<0.001), and a general consistency of those decisions with the man's values. Among those initially who had not made a decision, 83.1% made a decision by final survey with decisions equally for or against screening.

Conclusions: The intervention provides realistic, unbiased and effective decision support for men facing a difficult and confusing decision.

Practice implications: Our intervention could potentially replace a discussion of PSA testing with the PCP for most men.

Figure 1. Box Plot of Pro Sum Score-Con Sum Score by Stage at End of Counseling Call

Each box represents the interquartile range (middle 50% of values), the line in the box the median, the vertical lines the extent of the highest and lowest quartiles, and the dots represent values that lie more than 1.5 times the interquartile range from the median.