Medical Decision MakingMediated decision support in prostate cancer screening: A randomized controlled trial of decision counseling
Introduction
In 2010, there were an estimated 217,730 new cases of prostate cancer in the United States, and 32,050 deaths from the disease, making it the second leading cause of cancer-related death among men [1]. Prostate cancer is often diagnosed through prostate cancer screening, which includes digital rectal examination (DRE) and prostate specific antigen (PSA) testing.
Unfortunately, definitive evidence is lacking regarding the impact of screening on mortality and survival; screening carries a substantial risk for over-diagnosis; and there are serious complications associated with treatment for early-stage disease [2], [3], [4], [5]. A recent report from a large randomized trial conducted in the United States found that prostate cancer screening does not save lives [6], while data from a large European trial showed that screening may produce a modest reduction in mortality [7]. Both trials concluded, however, that mass screening with PSA results in substantial over-diagnosis and related morbidity. A recent report using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program is consistent with this view [8].
Current prostate cancer screening guidelines recommend that informed, shared decision making should be part of routine primary care for older adult men [9], [10], [11]. In practice, however, most men have little or no discussion about prostate cancer screening with a primary care provider [12]. Given this state of affairs, there is a pressing need for methods to facilitate informed and shared decision making about prostate cancer screening use [13]. Decision aids (e.g., print materials, telephone contacts, videos, and Internet tools for providing information), have been investigated as a means to increase patient prostate cancer screening knowledge and involvement in decision making about screening [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28]. The studies have sought to assess decision aid impact on patient knowledge, decisional conflict, and screening use.
This report presents findings from a randomized controlled trial, referred to as the Decision Counseling Trial (DCT). The DCT was designed to test the impact of nurse-mediated decision support on patient prostate cancer screening knowledge and decisional conflict (primary outcomes) and on informed decision making and actual screening use (secondary outcomes).
Section snippets
Study setting, participants, and procedures
The DCT was conducted between 2003 and 2007 with patients at two primary care practice sites in Philadelphia, PA. Patients included in the study were males who were 50–69 years of age, had no history of prostate cancer or benign prostatic hyperplasia (BPH), and did not have a PSA test in the previous 11 months. The trial was approved by the Institutional Review Boards of Thomas Jefferson University and the Einstein Health Care System in Philadelphia, Pennsylvania.
Prior to patient recruitment to
Results
Fig. 1 summarizes study accrual and randomization. In 30 months, we screened 2234 patients, determined 1245 were potentially eligible, contacted 891, and administered a baseline survey to 436. Of those patients surveyed, 313 (72%) were randomly assigned, either to the EI Group (n = 156) or the SI Group (n = 157). Decision counseling sessions for the EI Group men averaged 28 min (standard deviation = 14). On the endpoint survey, 97% of the EI Group respondents reported that they remembered discussing
Discussion
Our analyses show that prostate cancer screening knowledge at baseline was low and that knowledge at endpoint had increased among men in both study groups. This increase may be the result of exposure to the informational brochure sent to all participants before their office visit. However, we also found that the gains in knowledge were significantly greater in the EI Group than in the SI Group. Nurse educator review of the brochure in the decision counseling session is likely to have boosted
Acknowledgements
The Decision Counseling Trial was conducted under AAMC/CDC cooperative agreement grant MM-0554-03. The authors declare that there are no conflicts of interest. We wish to extend our sincere thanks to Dr. James Dolan his most valuable contributions as a consultant on the study and to Ms. Heidi Swan for her extremely helpful efforts in manuscript organization and editing.
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2019, Journal of Surgical ResearchCitation Excerpt :We further categorized each type of decision aid by medical condition (Table 1). Among decision aids designed for choosing between medical decisions, most were designed for patients with either screening for or genetic testing for the following conditions: prostate conditions (n = 18),15-32 cardiovascular disease (n = 11),33-43 colorectal cancer (n = 14),44-57 breast cancer (n = 13),58-70 endocrine disorders (n = 11),1,71-80 and women's health conditions (n = 10).81-90 Few studies assessed decision aids for medical decisions in other categories such as screening for congenital disorders,91-97 infectious diseases,98-102 orthopedic conditions,103-106 diabetes,107-112 psychiatric conditions,113-115 neurologic conditions,116,117 dental health conditions,118,119 and health behaviors.120
Coaching to support men in making informed choices about prostate cancer screening: A qualitative study
2018, Patient Education and CounselingCitation Excerpt :In Australia, the role of nurses in primary health care setting has increased, typically performing a variety of roles including simple clinical procedures, health promotion, implementation of prevention strategies, rehabilitation, clinical research, education and other public health affiliated roles. The only two studies conducted to date have demonstrated that the delivery of decision coaching by a nurse, or health educator, to provide supportive but non-directive information, can enhance patient skills and knowledge when making a decision with their GP with respect to prostate cancer testing [22,23]. Both studies were set in the United States, however no studies to date have been conducted in the context of the Australian health system to examine the reproducibility of these results given different cultural attitudes in screening.
Improving Health Screening Uptake in Men: A Systematic Review and Meta-analysis
2018, American Journal of Preventive MedicineCitation Excerpt :Of 12,867 articles screened, 54 studies met the inclusion criteria (Figure 1). An additional four studies were identified from reference follow-up, making a total of 58 studies (51 RCTs and seven cRCTs) included in this review.29–86 The studies evaluated effectiveness of interventions on screening for the following conditions: prostate cancer (k=31), HIV (k=11), sexually transmitted infection (STI) (k=4), HIV and STI (k=1), testicular cancer (k=3), melanoma (k=3), and combinations of more than one disease (k=5) which include colorectal cancer, gastric cancer, prostate cancer, cholesterol, and general health conditions (Appendix Tables 2 and 3, available online).
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2014, Contemporary Clinical TrialsCitation Excerpt :In addition, racial subgroup analysis by intervention group did not reveal significant differences in PCa screening related outcomes. Previous studies have investigated the efficacy of PCa decision aids and found no significant group differences for knowledge [44], decisional conflict [13,31,32,44,45], distress [31] or satisfaction with decision [27]. The lack of significant difference between intervention groups may reflect the small sample size, the homogeneity of the sample, or both intervention groups having received a decision aid.
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2024, Cochrane Database of Systematic Reviews