Decision making in prostate cancer screening using decision aids vs usual care: a randomized clinical trial.

MedStar author(s):
Citation: JAMA Internal Medicine. 173(18):1704-12, 2013 Oct 14.PMID: 23896732Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Multicenter Study | Randomized Controlled Trial | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov't | Research Support, U.S. Gov't, Non-P.H.S.Subject headings: *Decision Making | *Early Detection of Cancer/mt [Methods] | *Health Knowledge, Attitudes, Practice | *Informed Consent | *Patient Participation | *Prostatic Neoplasms/di [Diagnosis] | Aged | Decision Support Techniques | Follow-Up Studies | Humans | Internet | Male | Middle Aged | Retrospective StudiesYear: 2013ISSN:
  • 2168-6106
Name of journal: JAMA internal medicineAbstract: CONCLUSIONS AND RELEVANCE: Both decision aids improved participants' informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool.DESIGN, SETTING, AND PARTICIPANTS: A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures.IMPORTANCE: The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions.INTERVENTION: Random assignment to print-based decision aid (n=628), web-based interactive decision aid (n=625), or usual care (UC) (n=626).MAIN OUTCOMES AND MEASURES: Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening.OBJECTIVE: To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions.RESULTS: Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P <.001). At 1 month, the standardized mean difference (Cohen's d) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC (d=0.33) and print vs UC (d=0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P=.009) and significantly more web (P=.001) and print (P=.03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P=.06) and web participants (50.4%; P=.10) were not significant. Screening rates at 13 months did not differ significantly among groups.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00196807.All authors: Barry S, Cole C, Davis K, Fishman MB, Kelly S, Krist AH, Luta G, Miller E, Penek S, Schwartz M, Taylor KL, Tomko C, Williams RM, Woolf SHFiscal year: FY2014Date added to catalog: 2014-02-24
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 23896732 Available 23896732

CONCLUSIONS AND RELEVANCE: Both decision aids improved participants' informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool.

DESIGN, SETTING, AND PARTICIPANTS: A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures.

IMPORTANCE: The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions.

INTERVENTION: Random assignment to print-based decision aid (n=628), web-based interactive decision aid (n=625), or usual care (UC) (n=626).

MAIN OUTCOMES AND MEASURES: Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening.

OBJECTIVE: To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions.

RESULTS: Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P <.001). At 1 month, the standardized mean difference (Cohen's d) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC (d=0.33) and print vs UC (d=0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P=.009) and significantly more web (P=.001) and print (P=.03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P=.06) and web participants (50.4%; P=.10) were not significant. Screening rates at 13 months did not differ significantly among groups.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00196807.

English

Powered by Koha