0
Original Investigation |

Decision Making in Prostate Cancer Screening Using Decision Aids vs Usual Care:  A Randomized Clinical Trial

Kathryn L. Taylor, PhD1; Randi M. Williams, MPH1; Kimberly Davis, PhD1; George Luta, PhD2; Sofiya Penek, BA1; Samantha Barry, BA1; Scott Kelly, MS1; Catherine Tomko, BA1; Marc Schwartz, PhD1; Alexander H. Krist, MD, MPH3; Steven H. Woolf, MD3; Mary B. Fishman, MD4; Carmella Cole, MD5; Edward Miller, MD6
[+] Author Affiliations
1Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
2Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC
3Department of Family Medicine, Virginia Commonwealth University, Richmond
4Department of General Internal Medicine, Georgetown University Hospital, Washington, DC
5Division of General Internal Medicine, Washington Hospital Center, Washington, DC
6Medstar Physician Partners, Baltimore, Maryland
JAMA Intern Med. 2013;173(18):1704-1712. doi:10.1001/jamainternmed.2013.9253.
Text Size: A A A
Published online

Importance  The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions.

Objective  To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions.

Design, Setting, and Participants  A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures.

Intervention  Random assignment to print-based decision aid (n = 628), web-based interactive decision aid (n = 625), or usual care (UC) (n = 626).

Main outcomes and measures  Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening.

Results  Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P <.001). At 1 month, the standardized mean difference (Cohen’s d) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC (d = 0.33) and print vs UC (d = 0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P = .009) and significantly more web (P = .001) and print (P = .03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P = .06) and web participants (50.4%; P = .10) were not significant. Screening rates at 13 months did not differ significantly among groups.

Conclusions and Relevance  Both decision aids improved participants’ informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool.

Trial Registration  clinicaltrials.gov Identifier: NCT00196807

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption
Figure.
Consolidated Standards of Reporting Trials Flow Diagram

GUH indicates Georgetown University Hospital; MPP, MedStar Physician Partners; PCa, prostate cancer; WHC, Washington Hospital Center.aRemoved from the analysis of screening outcome but included for other analyses.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Chapter 22.2. Decision Making and the Patient

Users' Guides to the Medical Literature
The Role of Costs in Clinical Decision Making Remains Controversial

brightcove.createExperiences();