ABSTRACT
BACKGROUND
Patient decision aids facilitate informed decision making for medical tests and procedures that have uncertain benefits.
OBJECTIVE
To describe participants’ evaluation and utilization of print-based and web-based prostate cancer screening decision aids that were found to improve decisional outcomes in a prior randomized controlled trial.
DESIGN
Men completed brief telephone interviews at baseline, one month, and 13 months post-randomization.
PARTICIPANTS
Participants were primary care patients, 45-70 years old, who received the print-based (N = 628) or web-based decision aid (N = 625) and completed the follow-up assessments.
MAIN MEASURES
We assessed men’s baseline preference for web-based or print-based materials, time spent using the decision aids, comprehension of the overall message, and ratings of the content.
KEY RESULTS
Decision aid use was self-reported by 64.3 % (web) and 81.8 % (print) of participants. Significant predictors of decision aid use were race (white vs. non-white, OR = 2.43, 95 % CI: 1.77, 3.35), higher education (OR = 1.68, 95 % CI: 1.06, 2.70) and trial arm (print vs. web, OR = 2.78, 95 % CI: 2.03, 3.83). Multivariable analyses indicated that web-arm participants were more likely to use the website when they preferred web-based materials (OR: 1.91, CI: 1.17, 3.12), whereas use of the print materials was not significantly impacted by a preference for print-based materials (OR: 0.69, CI: 0.38, 1.25). Comprehension of the decision aid message (i.e., screening is an individual decision) did not significantly differ between arms in adjusted analyses (print: 61.9 % and web: 68.2 %, p = 0.42).
CONCLUSIONS
Decision aid use was independently influenced by race, education, and the decision aid medium, findings consistent with the ‘digital divide.’ These results suggest that when it is not possible to provide this age cohort with their preferred decision aid medium, print materials will be more highly used than web-based materials. Although there are many advantages to web-based decision aids, providing an option for print-based decision aids should be considered.
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REFERENCES
Stacey D, Bennett CL, Barry MJ, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;CD001431.
Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUA guideline. J Urol. 2013;190:419–26.
Smith RA, Brooks D, Cokkinides V, Saslow D, Brawley OW. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin. 2013;63:88–105.
U.S.Preventive Services Task Force. Screening for prostate cancer. Clinical summary of U.S. Preventive Services Task Force recommendation. 2012. Available at: http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalsum.pdf. Accessed July 22, 2014.
Feldman-Stewart D, Brennenstuhl S, Brundage MD. The information needed by Canadian early-stage prostate cancer patients for decision-making: stable over a decade. Patient Educ Couns. 2008;73:437–42.
Ilic D, Risbridger GP, Green S. The informed man: attitudes and information needs on prostate cancer screening. J Mens Health Gend. 2005;2:414–20.
Woolf SH, Krist AH, Johnson RE, Stenborg PS. Unwanted control: how patients in the primary care setting decide about screening for prostate cancer. Patient Educ Couns. 2005;56:116–24.
Taylor KL, Williams RM, Davis K, et al. Decision making in prostate cancer screening using decision aids vs usual care: a randomized clinical trial. JAMA Int Med. 2013;173:1704–12.
Linnan L, Steckler A, eds. Process Evaluations for Public Health Interventions and Research. San Francisco: Jossey-Bass; 2002.
Oakley A, Strange V, Bonell C, Allen E, Stephenson J. Process evaluation in randomised controlled trials of complex interventions. BMJ. 2006;332:413–6.
Frosch DL, Kaplan RM, Felitti VJ. A randomized controlled trial comparing internet and video to facilitate patient education for men considering the prostate specific antigen test. J Gen Intern Med. 2003;18:781–7.
Gattellari M, Ward JE. A community-based randomised controlled trial of three different educational resources for men about prostate cancer screening. Patient Educ Couns. 2005;57:168–82.
Lepore SJ, Wolf RL, Basch CE, et al. Informed decision making about prostate cancer testing in predominantly immigrant black men: a randomized controlled trial. Ann Behav Med. 2012;44:320–30.
Taylor KL, Davis JL III, Turner RO, et al. Educating African American men about the prostate cancer screening dilemma: a randomized intervention. Cancer Epidemiol Biomarkers Prev. 2006;15:2179–88.
Volk RJ, Jibaja-Weiss ML, Hawley ST, et al. Entertainment education for prostate cancer screening: a randomized trial among primary care patients with low health literacy. Patient Educ Couns. 2008;73:482–9.
Williams RM, Davis KM, Luta G, et al. Fostering informed decisions: a randomized controlled trial assessing the impact of a decision aid among men registered to undergo mass screening for prostate cancer. Patient Educ Couns. 2013;91:329–36.
Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006-483). Available at: http://files.eric.ed.gov/fulltext/ED493284.pdf. Accessed July 22, 2014. Washington, DC: U.S. Department of Education, National Center for Education Statistics; 2006.
Dorfman CS, Williams RM, Kassan EC, et al. The development of a web- and a print-based decision aid for prostate cancer screening. BMC Med Inf Decis Making. 2010;10:12.
Kassan EC, Williams RM, Kelly SP, et al. Men's use of an Internet-based decision aid for prostate cancer screening. J Health Commun. 2012;17:677–97.
Lipkus IM, Samsa G, Rimer BK. General performance on a numeracy scale among highly educated samples. Med Decis Making. 2001;21:37–44.
Levinson W, Kao A, Kuby A, Thisted RA. Not all patients want to participate in decision making. A national study of public preferences. J Gen Intern Med. 2005;20:531–5.
Murray E, Pollack L, White M, Lo B. Clinical decision-making: Patients' preferences and experiences. Patient Educ Couns. 2007;65:189–96.
Wilkes M, Srinivasan M, Cole G, Tardif R, Richardson LC, Plescia M. Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening. J Gen Intern Med. 2013;28:1410–9.
Hall IJ, Taylor YJ, Ross LE, Richardson LC, Richards TB, Rim SH. Discussions about prostate cancer screening between U.S. primary care physicians and their patients. J Gen Intern Med. 2011;26:1098–104.
Acknowledgements
The authors would like to thank the participants who volunteered their time to participate in this study and to thank Susan Marx for her administrative support. Sources of funding include the National Cancer Institute (R01 CA119168-01) and Department of Defense (PC051100) to KLT. Additional support was provided by the Lombardi Comprehensive Cancer Center (LCCC) Biostatistics and Bioinformatics Shared Resource and the LCCC Cancer Center Support Grant. Results from this manuscript will be presented at the 35th Annual Meeting of the Society of Behavioral Medicine, Philadelphia, PA.
Conflicts of Interest
None of the authors have any conflicts of interest or financial disclosures to report.
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Tomko, C., Davis, K.M., Luta, G. et al. A Comparison of Web-Based Versus Print-Based Decision Aids for Prostate Cancer Screening: Participants’ Evaluation and Utilization. J GEN INTERN MED 30, 33–42 (2015). https://doi.org/10.1007/s11606-014-2994-7
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DOI: https://doi.org/10.1007/s11606-014-2994-7