Decision Aids for Prostate Cancer Screening Choice

Riikonen, Jarno; Guyatt, Gordon; Kilpeläinen, Tuomas P.; Craigie, Samantha; Agarwal, Arnav; Agoritsas, Thomas; Couban, Rachel; Dahm, Philipp; Järvinen, Petrus; Montori, Víctor M.; Power, Nicholas; Richard, Patrick O.; Rutanen, Juha; Santti, Henrikki; Tailly, Thomas; Violette, Philippe D.; Zhou, Qi; Tikkinen, Kari A.O.

doi:10.1001/jamainternmed.2019.0763

Cited by 42 publications

(34 citation statements)

References 57 publications

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“…However, improvements in knowledge did not translate into changes in screening preferences. Our finding of increased knowledge is consistent with other DA interventions among general audiences [35,36] and among African American men [28,37,38]. Our finding of an average 13 percentage point increase in prostate cancer knowledge is in line with these previous reports [28].…”

Section: Renderxsupporting

confidence: 92%

“…We found that men had less decisional conflict after using PCSPrep, which is also consistent with prior DA studies [35,36]. Presumably, improvements in knowledge and clarification of preferences reduces men's ambivalence about decision making and improves decision quality.…”

Section: Renderxsupporting

confidence: 89%

“…This is among the first DAs designed for African American men that integrate personalized risk estimates and other interactive functions, including values clarification exercises. We also specifically addressed the issue of false-positive test results in the DA, which has been called for in two recent systematic reviews of prostate screening DAs [35,36]. These features may enhance attention to messages, increase understanding and recall, and potentially lead to improved quality of decisions.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid

Allen¹,

Reich²,

Cuevas³

et al. 2020

JMIR Mhealth Uhealth

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Background African American men are at a higher risk of developing and dying from prostate cancer compared to white men. The serum prostate-specific antigen (PSA) screening test has a high risk of false-positive results and overdiagnosis; therefore, it is not routinely recommended. Rather, men are encouraged to make individualized decisions with their medical providers, after being fully informed about its potential benefits, limitations, and risks. Objective This study aimed to describe the development and pilot testing of an interactive Web-based decision aid (DA; Prostate Cancer Screening Preparation [PCSPrep]) for African American men, designed to promote informed decision making for prostate cancer screening. Methods Four focus groups (n=33) were conducted to assess men’s reactions to DAs developed in prior studies and gather information to modify the content and format. The pilot test employed a pre-posttest evaluation design. A convenience sample of 41 men aged 45-70 years with no history of prostate cancer was recruited from community settings. Participants completed online surveys before and after using PCSPrep that assessed prostate cancer screening knowledge, decision self-efficacy, decisional conflict, and preparation for decision making. Results Use of PCSPrep was associated with a significant increase in prostate cancer knowledge (49% vs 62% correct responses; P<.001), and men also experienced less decisional conflict (24 vs 15 on a scale of 0-100; P=.008). No changes in self-efficacy about decision making or screening preferences were observed. Most men (81%) reported that using PCSPrep prepared them to make informed decisions in partnership with their provider. Conclusions PCSPrep was an acceptable DA that improved men’s knowledge, reduced decisional conflict, and promoted the perception of being prepared for shared decision making. Further research is needed to test the DA in a larger randomized trial.

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Section: Renderxsupporting

confidence: 92%

Section: Renderxsupporting

confidence: 89%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid

Allen¹,

Reich²,

Cuevas³

et al. 2020

JMIR Mhealth Uhealth

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“…The results demonstrate that the majority of prostate cancer decision aids could increase patient knowledge on the subject, but were not specifically geared to facilitate shared decision-making. 114…”

Section: Clinical Ethicsmentioning

confidence: 99%

A discussion on controversies and ethical dilemmas in prostate cancer screening

Mishra

2020

J Med Ethics

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Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions.

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“…Health-education and screening programs, and culturally appropriate educational outreach and easier access to healthcare are efforts targeted toward AA men, and are needed to address significant healthcare disparities (3). There is consensus in literature since at least 2016 that separate screening guidelines are likely needed for AA men (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Shared Compared to Informed Decision Making for Prostate Cancer Screening in a High-Risk African American Population: A Randomized Control Trial

Carlson

Grivas

Wei

et al. 2021

Cancer Investigation

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Background: Prostate cancer incidence and mortality in the United States in African Americans (AA) are higher than in Caucasians. Eastern Cuyahoga County in Ohio is majority AA and is considered an underserved population particularly vulnerable to healthcare disparities. There is a paucity of data about shared decision making among high-risk AA men with regard to prostate cancer screening. This study aims to examine shared versus informed decision making (SDM versus IDM) in a randomized, control trial among a large, high-risk AA population. Methods: Patients were included in annual one-day outreach events, each held over 3 years (2017)(2018)(2019), and were randomized at each event into IDM (control) and SDM (investigational) groups and then were offered screening via prostate specific antigen (PSA) and digital rectal exam (DRE). The primary endpoints were proportion of participants over 40 who did not demonstrate decisional conflict about prostate cancer screening measured by the SURE score, as well as change of knowledge score about prostate cancer screening. Results: Overall, 175 patients were enrolled in the trial; 79 in the SDM arm and 96 in the IDM arm. The investigational (SDM) arm had 3/79 (3.9%) conflict versus 6/96 (6.4%) in the control (IDM) arm (p ¼ 0.74). With regard to knowledge improvement, the SDM cohort demonstrated improvement following educational tools for 66/79 (81%) of participants versus 76/96 (79%) in the IDM cohort (p ¼ 0.85). There was no difference in the proportion (63%) of participants in either group who found the information very helpful (using a Likert scale). Conclusions: Our education-based study showed no significant difference between SDM and IDM with regard to decisional conflict about prostate cancer screening. The study also demonstrated significant improvement in knowledge about prostate cancer screening in a high-risk AA population in both groups. Our results should be interpreted with caution due to several limitations; however, the study can serve as a benchmark for future studies in this very important topic.

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Decision Aids for Prostate Cancer Screening Choice

Cited by 42 publications

References 57 publications

Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid

Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid

A discussion on controversies and ethical dilemmas in prostate cancer screening

The Effectiveness of Shared Compared to Informed Decision Making for Prostate Cancer Screening in a High-Risk African American Population: A Randomized Control Trial

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