Information needs of men regarding prostate cancer screening and the effect of a brief decision aid

https://doi.org/10.1016/j.pec.2003.12.003Get rights and content

Abstract

Background: Little is known about what information affects men’s decisions about prostate cancer screening. Methods: We developed a four-part decision aid about prostate cancer screening and tested it in men, ages 45–85, to determine how the information in each part—(1) the epidemiology of prostate cancer; (2) the PSA test; (3) prostate biopsy and treatment options for prostate cancer; and (4) balance sheets to aid decision-making—affected men’s interest in screening. Results: One hundred eighty-eight men from one general internal medicine clinic participated in our study (response rate 65%). Before the decision aid, 76% were interested in screening; 8% were not; and 16% were undecided. The decision aid increased the proportion of men who knew the advantages (+28%; 95% CI: 21–35) and disadvantages (+55%; 95% CI: 48–63%) of screening. It also increased the proportion who knew enough to make a decision (+24; 95% CI: 16–32%). It did not change mens’ interest in screening (P=0.134). Twenty percent of men, however, did change their interest category. Men who were undecided at baseline were more likely to change than those who were interested or not interested. There were no clinically meaningful changes in interest following each component part of the decision aid. Conclusion: Interest in prostate cancer screening is high and remained high after a 10 min decision aid. The decision aid increased the proportion of men with sufficient information to decide about screening. It also changed 20% of men’s interest in screening. Because no single piece of information was influential to decision-making in all men, clinicians may want to tailor information to men’s individual needs.

Introduction

Several professional organizations now recommend that men should participate in decision-making about prostate cancer screening [1], [2], [3] due to the unknown benefits of screening in the face of potential physical, psychological, and financial harms. Such recommendations are responsive to a call from decision-making experts to include patients in decisions that may be sensitive to individuals’ personal values and preferences based on the uncertainty of the evidence or a close balance between potential harms and benefits [4], [5], [6], [7], [8], [9], [10].

One way to encourage participation is through the use of decision aids, which are multi-media tools that provide balanced, evidence-based information and values clarification for a decision [11], [12] Decision aids on prostate cancer screening have been shown to increase knowledge about prostate cancer screening [13], [14], [15], [16]. Additionally, some have been shown to decrease interest in screening and use of screening tests [13], [14], [15], [16], [17]. Little is known, however, about which information in these decision aids affects men’s decisions about prostate cancer screening. Such information could help clinicians better deliver information on prostate cancer screening and could lead to the development of more effective and efficient decision aids.

In this study, we developed a pamphlet-based decision aid on prostate cancer screening and used it to measure which information had an effect on men’s interest in screening and what proportion of men changed their interest in screening after viewing the decision aid.

Section snippets

Designing and developing the decision aid

We developed a four-part decision aid that included information about (1) the natural history and epidemiology of prostate cancer, (2) the prostate specific antigen test, (3) the prostate biopsy and treatment options available for prostate cancer, and (4) the harms and benefits of screening presented in two balance sheets designed to promote the unbiased weighing of personal preferences. A detailed summary of the information we presented is listed in Fig. 4. The full decision aid is available

Results

We approached 313 men about participation in our study. Ninety-eight (31%) refused and 23 (7%) were ineligible because they had a prior history of prostate cancer (n=6), could not read, write, or speak English (n=8), or did not complete the decision aid and survey (n=9). One hundred eighty-eight men were determined to be eligible and agreed to participate in our study for a response rate of 65%.

Table 1 provides information about the study participants. Mean age was 60. Seventy percent were

Discussion

Interest in prostate cancer screening among patients in a university internal medicine clinic was high and remained high even after a brief decision aid. The decision aid increased the proportion of men who knew the advantages and disadvantages of screening and increased the proportion who knew enough to make a decision. It did not affect mean interest in screening, although 20% of men changed their interest category after viewing the decision aid. Men who were undecided at baseline were more

Practice implications

Despite the limitations, we believe our study has important implications for clinical practice. Because no one piece of information is influential to decision-making in all men, clinicians may want to tailor information to men’s individual needs. In deciding what information is necessary to present, clinicians should consider that a substantial portion of men do not know that whether to be screened or not is a decision and they do not feel they know the harms of screening. Decision aids can

Acknowledgements

This work was supported by a University Research Council Grant through the Lineberger Comprehensive Cancer Center. Dr. Sheridan was additionally supported by a National Research Services Award (Public Health Service Grant #PE 14001-14). Drs. Pignone and Lewis were additionally supported by the American Cancer Society Career Development Awards (#01-195-01 and #00-180-00).

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