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

Abstract

Objectives: Efforts to educate men about the controversy surrounding prostate cancer screening are well intended but rarely evaluated rigorously. We evaluated an evidence-based (EB) booklet for men designed to promote informed decision-making. We also determined whether men's preference for involvement in decision-making ("passive", "collaborative" or "active") modified its impact. Setting and methods: Men aged 40-70 years were recruited from the practices of 13 local general practitioners (GPs) in Sydney, Australia. They completed a self-administered questionnaire before seeing their GP, who, according to pre-randomised codes, distributed either our EB booklet or conventional information. Post-test questionnaires were mailed to men three days later. Of the 248 eligible men recruited, 214 (86% response rate) returned post-test questionnaires. Knowledge of evidence and of risk of developing and dying from prostate cancer, attitudes, interest in screening for prostate-specific antigen (PSA), worry and decisional conflict were the main outcome measures. Results: Compared with those receiving conventional information, men receiving the EB booklet had significantly improved knowledge (50% of items correct, 95% CI 46-53%; vs 45% correct, 95% CI 42-48%) (p=0.048) and lower levels of decisional conflict (mean 21.6, 95% CI 20.7-22.5; vs mean 24.3, 95% CI 23.4-25.2) (p<0.001). Interest in PSA screening was significantly reduced in both groups at post-test (p<0.001). Men preferring a "passive" approach to decision-making gained as much from our EB booklet as those with "active" or "collaborative" preferences. Conclusions: Our findings show the benefits of providing evidence-based information to men about PSA screening. Our EB booklet facilitated informed choice, even among "passive" decision-makers.

Informing Men about Prostate Cancer Screening: A Randomized Controlled Trial of Patient Education Materials

“…The outcomes of this study also add to findings from previous studies that have identified the beneficial impact of prostate cancer education materials on patient decisional conflict, knowledge, anxiety, and role in the decision-making process. [9][10][11][12][13][14][15][16][17][18][19][20] However, this study is the first to directly compare patient information on prostate cancer screening delivered through video, internet, and written formats to men previously not screened for prostate cancer, and suggest that media format may not significantly alter these clinical outcomes.…”

“…Both formats have been associated with an increase in patient health knowledge, a shift toward an active or shared decision-making process, a decrease in patient decisional conflict, and a preference to not undergo screening for prostate cancer. [9][10][11][12][13][14][15][16][17][18][19][20] To date, only one study has investigated the effectiveness of the internet as a patient education tool for prostate cancer screening. It compared information delivered via the internet and video and identified increases in patient knowledge and a decrease in patient preference for prostate cancer screening across both interventions.…”

Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

“…Interventions that may help correct misperceptions include: having family members present at meetings with doctors to ask additional questions and record information; explaining treatment options and treatmentrelated mortality and outcome estimates a number of times (either through the use of educational materials, particularly interactive educational materials such as CD-ROMs, or through repeat visits with health care personnel and reiteration of estimates); testing patient understanding of these estimates, to verify that informed consent truly has been given; and early involvement of psychiatry and social services, when appropriate. [49][50][51][52][53][54] …”

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

“…Values Clarification Tool-The values clarification tool is a 10-item tool to help men better understand their preferences regarding screening [38]. The 10 items appear throughout the website in the relevant content sections.…”