Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster Randomized Controlled Trial

Abstract

BACKGROUND Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. METHODSOur study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Webbased educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening.RESULTS Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control = 38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A = 50%, MD-Ed = 33%, control = 15%; P <.05). Of the male patients, 80% had had previous PSA tests. CONCLUSIONSAlthough activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.

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

“…While we have controlled for these factors in our current analyses, these significant demographic differences speak to the larger issue of the need to expand the availability and usability of web-based decision aids for groups who may not have access to this information. Previous studies have shown evidence that incorporating web-based decision aids into primary care appointments can improve rates of decision aid use [25,27,41].…”

The Role of Patient Activation in Preferences for Shared Decision Making: Results From a National Survey of U.S. Adults

“…The relationship between activation and SDM preferences is underinvestigated, but preliminary evidence suggests that activating patients can increase SDM (Wilkes et al, 2013). Activated patients seek more health-related information and are more knowledgeable about health care (Butler, Farley, Sleath, Murray, & Maciejewski, 2012;Fowles et al, 2009;Harvey, Fowles, Xi, & Terry, 2012).…”

Web-Based Study for Improving Mammography Among Korean American Women

“…There have been relatively few studies using a Web-based intervention to promote cancer screenings. Most of these are clinic-based interventions that have focused on colorectal cancer screening [20][21][22] and prostate cancer screenings [23,24]. Despite its value in health education, Web-based educational interventions to improve women's BC screening uptakes have not been conducted with KA women.…”