Decision aids help inform prostate cancer screening

Print and web-based decision aids (DAs) could be beneficial informants in prostate cancer screening decision-making processes, according to a study published on Oct. 14 in JAMA Internal Medicine.

Prostate cancer is the most common cancer diagnosis among men and the second leading cause of male cancer deaths. Importantly, screening for the disease is not as straightforward as many tend to think. Both benefits and risks exist for patients who undergo prostate cancer screening, and the U.S. Preventive Services Task Force (USPSTF) recommends against routinely screening all men for prostate screening as a result of these truths.

“Given the balance of benefits and harms, patients and clinicians will continue to face the difficult decision about whether to screen, making the promotion of informed decisions critical,” wrote Kathryn L. Taylor, PhD, of the Georgetown University Medical Center, and colleagues in their study.

Decision aids are key to making educated medical decisions such as this one. The study’s authors thus decided to assess the effectiveness of two decision aids in helping men make informed screening decisions, as well as compare the DAs’ effectiveness on informed decision making outcomes, through a randomized clinical trial.

The study’s sample population was comprised of 1, 879 male primary care outpatient participants from three Washington D.C.-based health systems. Participants were 45-70 years old, had no history of prostate cancer, were independently living, English speaking, and could give informed consent. Researchers mailed invitations to all eligible patients during the clinical trial’s 27-month accrual period and called the men five days later for a 20-minute baseline interview. Participants were then assigned in a 1:1:1 ratio to web DA, print DA, or usual care by a computer generated random allocation sequence.

The first follow-up was completed one month after the randomization, while the final assessment was done 13 months after randomization. During this time, participants reported if they received a prostate specific antigen (PSA) test and/or a digital rectal exam (DRE) during the one year study.

Statistical analyses of variance and standardized mean differences were calculated by the researchers. Participation rate for the trial was 39 percent, with a retention rate of 89 percent at the one month follow-up and an 84 percent retention rate at the final assessment.

Results indicated that print and web-based DAs were more effective in the decision-making process than usual care. The print DAs illustrated significant improvements in decisional satisfaction than the usual care at both follow-up assessments and in significant improvements over web decision aids at one month. The trial’s findings demonstrate a possibility of greater decision making ease with print DAs than web-based DAs.

“Given the demonstrated beneficial effects of these DAs, work is now needed to understand how to deliver them to patients in a systematic manner,” wrote Taylor and colleagues.  “The ongoing questions concerning the impact of PCa screening on disease-related mortality and on men’s long-term quality of life highlight the need for promoting widespread informed decision making among patients and their physicians.”