Entertainment education for prostate cancer screening: A randomized trial among primary care patients with low health literacy

Abstract

Objective-To evaluate an entertainment-based patient decision aid for prostate cancer screening among patients with low or high health literacy.Methods-Male primary care patients from two clinical sites, one characterized as serving patients with low health literacy (n=149) and the second as serving patients with high health literacy (n=301), were randomized to receive an entertainment-based decision aid for prostate cancer screening or an audiobooklet-control aid with the same learner content but without the entertainment features. Postintervention and 2-week follow-up assessments were conducted.Results-Patients at the low-literacy site were more engaged with the entertainment-based aid than patients at the high-literacy site. Overall, knowledge improved for all patients. Among patients at the low-literacy site, the entertainment-based aid was associated with lower decisional conflict and © 2008 Elsevier Ireland Ltd. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Conflict of Interest None. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript greater self-advocacy (i.e., mastering and obtaining information about screening) when compared to patients given the audiobooklet. No differences between the aids were observed for patients at the high-literacy site.Conclusions-Entertainment education may be an effective strategy for promoting informed decision making about prostate cancer screening among patients with lower health literacy.Practice Implications-As barriers to implementing computer-based patient decision support programs decrease, alternative models for delivering these programs should be explored.

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

“…In other randomized controlled trials that included a web-based decision aid for PCa screening, participant knowledge consistently improved [21][22][23][24][25][26][27][28], while decisional conflict results were more variable, with some studies reporting a decrease compared to Implications Practice: Clinicians should encourage the use of web-based decision aids to help patients become aware of the facts associated with medical tests and treatments and to aid informed decision making.…”

“…Tracking software captured website use, allowing for an investigation of whether use of informational sections, testimonial videos, and the values clarification tool were associated with decisional outcomes. Based on prior studies in several domains [14,28,[31][32][33][34] and on a model of Internet interventions [14], we hypothesized that greater interaction with the website would be associated with improved knowledge and satisfaction, decreased decisional conflict, and decreased screening rates.…”

A Comparison of Web-Based Versus Print-Based Decision Aids for Prostate Cancer Screening: Participants’ Evaluation and Utilization

“…While participants in the print arm reported that the decision aid was a better length than participants in the web arm, we found few differences between the print and web arms. 15 For example, men in each arm had a similar response to the patient-physician communication outcomes and to the decision aid content, with few people reporting difficulty understanding the information and most reporting that the decision aids were very or extremely helpful. In multivariable, adjusted analyses, men were equally likely to understand that the overall message of the decision aid was neutral with regard to screening.…”

“…Another study limitation was the overall participation rate of 39.5 %. However, this rate is typical of decision aid studies that enrolled participants by mail and telephone as opposed to in conjunction with an office visit, 11,15 and has the advantage of yielding a sample that is potentially more generalizable, as participants had fewer eligibility restrictions.…”

“…10 Previous trials of decision aids for prostate cancer screening have reported very favorable participant ratings of decision aid clarity and helpfulness. [11][12][13][14][15][16] Decision aid content was typically rated as neutral (i.e., neither encouraging nor discouraging screening) compared to usual care. [11][12][13]16 Although these studies evaluated patient responses to decision aids, we are aware of no study that has assessed the potential influence of demographic and clinical variables on the likelihood of using and understanding the materials.…”