Tools Affect Prostate Cancer Screening Decisions, Not Rates

Both Internet and print-based decision aids equally helped men make important decisions related to prostate cancer screening. Both of the aids resulted in men who were better educated about screening options up to 13 months later. The results of this education study are published in JAMA Internal Medicine.

The study showed that the screening education tool did not affect actual screening rates.

According to Kathryn L. Taylor, PhD, of Georgetown University in Washington, DC, and colleagues, the decision aid could be a valuable public health tool.

Taylor and colleagues sought to understand the effect of decision aids that aim to educate patients about the benefits and harms, as well as the scientific data showing that outcomes are ambiguous. Studies show that most men both overestimate the benefits of prostate cancer screening and are not acutely aware of the limitations to screening.

The current study is a large, randomized trial comparing Internet-based and print-based decision aids with usual care. A total of 1,893 men between the ages of 45 and 70 who had no prior history of prostate cancer in the Washington, DC area participated in the study. The study authors measured knowledge of prostate cancer, the conflict in making a screening decision, whether the participant opted to undergo prostate cancer screening, and the participant’s satisfaction with his decision. The study is the largest one assessing a decision aid for prostate cancer screening.

At each patient follow-up, those who were given overview of screening and prostate cancer knowledge, using the decision aid, had a significantly better knowledge of prostate cancer and a decrease in conflict over the decision of whether or not to undergo screening. The decision conflict was significantly lower for those who used both the Internet and print-based material compared with usual care one month following access to the decision aid. Thirteen months later, the results were still statistically significant, but to a smaller extent.

In comparing the Internet version with the print version, those who used the print version reported a higher satisfaction with the tool compared with those who studied the material via the Web (60.4% satisfaction vs 52.2% for the print and the Internet versions, respectively (P = .009). Both groups who used the decision aid had a higher satisfaction compared with those who received usual care from their clinician. Thirteen months out, the differences in satisfaction for the Internet and print-based material were similar.

The screening rates for all three groups at 13 months after decision aid use did not differ. At 13 months, 58.3% of participants reported having undergone screening (mostly by prostate-specific antigen testing) compared with a baseline rate of 59.3%.

The decision aid consists of six sections: introductory information on the prostate gland, screening tests and possible results, treatment options and their associated risks and adverse effects, prostate cancer risk factors, encouragement to discuss prostate cancer screening with a clinician, and a list of resources for further information. The Internet edition includes a voice-over, as well as interactive definitions, figures, and graphics.

Because face time with clinicians is limited, but the knowledge necessary to make an informed decision is at least partly complex, decisions made by men on screening for prostate cancer may not always be maximally informed.

A weakness of the current study is the 39.5% rate of trial participation (a total of 4,794 patients were eligible).

The authors conclude that similar decision aids can be incorporated well into real-world practice. Additionally, the decision aids “offer neutrality,” as the use of the aids did not influence the rate of screening compared with usual care. The complex prostate cancer screening decision is at least partly subjective. The more knowledge provided to men who are candidates for screening, the more likely these men can make personal decisions on screening facilitated by their clinician.

In an accompanying editorial, Daniel S. Reuland, MD, and Michael Pignone, MD, both of the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina, conclude, based on the study results, that decision aids can have “more than a transient effect on patients’ knowledge, perceived uncertainty, and satisfaction” in terms of their healthcare decisions. The two editorial authors also highlight that new cancer screening methods need to be analyzed for both the benefits and the potential harms of the screening approach.