Informed decision making and prostate specific antigen (PSA) testing for prostate cancer: A randomised controlled trial exploring the impact of a brief patient decision aid on men's knowledge, attitudes and intention to be tested

https://doi.org/10.1016/j.pec.2006.05.005Get rights and content

Abstract

Objective

To examine the impact of a brief patient decision aid (pDA) on men's knowledge, attitudes and intention to have a prostate specific antigen (PSA) test. To explore the important predictors of intention to be tested in men who received the brief pDA.

Methods

A brief pDA designed to facilitate informed decision-making for men considering PSA testing was developed for the NHS Prostate Cancer Risk Management Programme. Men aged 40–75 years selected from 11 General Practices in England and Wales were randomised to receive either a mailed copy of the brief pDA and a questionnaire (intervention group), or a questionnaire alone (control group). The questionnaire assessed knowledge, attitudes, perceived risk and intention to have a PSA test and, for the intervention group, their perceptions of the brief pDA.

Results

Nine hundred and ninety of the men who were eligible for the study returned completed questionnaires (response rate = 54%). Men who received the brief pDA had significantly higher knowledge scores (p < 0.0001) and less positive attitudes (p < 0.0001) regarding PSA testing than men in the control group. There was no significant difference between the two groups in intention to be tested within the next 12 months. 87% of men found the brief pDA was easy to read, 94% considered it contained about the right amount of detail and 94% felt the information was presented in a balanced way. Multivariate analysis identified perceived risk (p < 0.0001), perceived benefits of PSA testing (p < 0.0001), knowledge (p = 0.004), attitude (p = 0.007) and age (p = 0.01) as the most important independent predictors of intention to be tested amongst men in the intervention group.

Conclusion

The brief pDA was shown to dramatically increase men's knowledge of the benefits and risks of the PSA test. Men who received the brief pDA were significantly less positive about the PSA test, although there was no difference between the two groups regarding their intention to be tested within the next year.

Practice implications

This brief pDA could serve as an acceptable and low cost adjunct to counselling by the General Practitioner (GP), and should promote informed decision making regarding the PSA test. Further research is required to ascertain the utility of the decision aid during the consultation.

Introduction

Prostate cancer is a major cause of morbidity and mortality in men [1]. Controversy continues to surround the role of PSA screening in the early identification and treatment of localised disease [2], and research efforts have been directed towards establishing effective ways of communicating the potential benefits and risks of PSA testing to men [3], [4], [5], [6], [7], [8]. Current policy in the UK is that any man can have a PSA test “provided he has been given full information about the benefits and limitations of the test” – no formal screening programme is in place [9]. In order to assist men to understand the complexities about PSA testing and make an informed decision about testing, the Prostate Cancer Risk Management Programme (PCRMP) has developed an information pack which has been circulated to all GPs in England and Wales [10]. The information pack includes a brief patient decision aid (pDA) in the form of an A4 written sheet, and the intention is that men who consult their GP about the PSA test receive this sheet and have an opportunity to discuss the issues.

It is increasingly recognised as important that individuals are informed in decisions about their health care, and this extends to decisions about participating in cancer screening [11]. Indeed, various interventions have been developed to promote informed decision making in relation to cancer screening. These interventions are generally consistent in improving individuals’ knowledge about the disease, accuracy of risk perceptions, or knowledge and beliefs about the pros and cons of screening and treatment options [12]. A systematic review of existing PSA testing decision aids concluded that men who received a decision aid were less likely to have a PSA test [13]. A recent Swedish study identified having a positive attitude towards the test [7] as the most important predictor of test uptake. A study from the US identified age, income, employment status, perceived control of health and perceived health status as being related to participation in PSA screening [14], and an Australian study identified age and visiting a doctor for urinary symptoms as significant independent predictors of having a PSA test [15].

We could find no previous published work from the UK addressing men's knowledge and attitudes regarding PSA testing and hence the primary purpose of this study was to examine the impact of the brief pDA on men's knowledge, attitudes and intention to have a PSA test. Of secondary interest was men's views on the acceptability and usefulness of the brief pDA, as well as exploration of factors which might influence intention to have a PSA test in men who received the brief pDA.

Section snippets

Participants and recruitment

Participants were recruited from 11 GP practices in England (Oxfordshire and Hertfordshire) and Wales (Cwmbran and Aberystwyth) between January and August 2004. Men were eligible for the study if they were aged 40 to 75 years, and did not have a history of prostate cancer. The sample was drawn from the practice computerised age-sex registers and was stratified by age group (40–49; 50–59; 60–69; 70–75 years). Participant flow through the study is summarised in Fig. 1. Selected men were

Response rate

One thousand, nine hundred and sixty questionnaires were mailed out. One hundred and seven were returned as undelivered. Six respondents were classed ineligible because they had previously had prostate cancer (n = 4) or they received the wrong intervention (n = 2). A total of 990 completed questionnaires were returned from 1847 eligible men, giving an overall response rate of 53.6% (990/1847). Participant flow is summarised in Fig. 1. The response rate was slightly lower in the brief pDA group than

Discussion

This study has shown that in the UK men's awareness of and knowledge regarding the PSA test and prostate cancer is low, but that their attitudes regarding PSA testing are largely positive. Provision of a brief pDA designed to help men make an informed decision as to whether or not to have a PSA test lead to significant improvements in knowledge, and significantly less positive attitudes about the test. However, there were no significant differences in intention to be tested within the next 12

Acknowledgements

We would like to thank the following GP practices for participating in this study: Bury Knowle Health Centre, Oxford, Oxfordshire; Church Street Practice, Wantage, Oxfordshire; Church Surgery, Aberystwyth, Ceredigion; Cwmbran Village Surgery, Cwmbran, Torfaen; Dolphin House Surgery, Ware, Hertfordhsire; East Oxford Health Centre, Oxford, Oxfordshire; Jericho Health Centre, Oxford, Oxfordshire; 19 Beaumont St., Oxford, Oxfordshire; Summertown Health Centre, Oxford, Oxfordshire; The Surgery,

References (34)

  • R.J. Volk et al.

    A randomized, controlled trial of shared decision making for prostate cancer screening

    Arch Fam Med

    (1999)
  • M.R. Partin et al.

    Randomized trial examining the effect of two prostate cancer screening educational interventions on patient knowledge, preferences, and behaviors

    J Gen Int Med

    (2004)
  • D.L. Frosch et al.

    Evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test

    J Gen Int Med

    (2001)
  • M. Gattellari et al.

    Does evidence-based information about screening for prostate cancer enhance consumer decision-making? A randomised controlled trial

    J Med Screen

    (2003)
  • National Screening Committee. Prostate Cancer Risk Management Programme. August,...
  • E. Watson et al.

    Prostate cancer risk management programme: an information pack for primary care

    (2002)
  • National Screening Committee. Second Report of the National Screening Committee. London: Department of Health;...
  • Cited by (101)

    • Improving patient-clinician communication following nephrectomy in renal cell carcinoma: Development, content validation and pilot testing of a conversation aid tool

      2021, Patient Education and Counseling
      Citation Excerpt :

      The newly developed CAT consists of a brief introduction and question prompt list [13]. Findings from previous research demonstrates that the use of decision aids improved knowledge of their condition in patients with cancer [14–17]. Furthermore, research in decision aids has highlighted the need to consider patients’ emotions in treatment decision making and the need to include information that is considered important to patients in adequate detail (e.g., not just 'cancer spreading' but explaining the location and expected timelines) [15,17].

    View all citing articles on Scopus
    View full text