Abstract
Informed decision-making tools are recommended for men considering prostate cancer screening. We evaluated the extent to which use of an interactive, web-based decision aid was associated with decisional and screening outcomes. Participants (N = 253) were 57 (7.0) years old and completed telephone interviews at baseline, 1 month, and 13 months post-baseline. Tracking software captured minutes spent on the website (median = 33.9), sections viewed (median = 4.0/5.0), testimonials viewed (median = 4.0/6.0), and values clarification tool (VCT) use (77.3 %). In multivariable analyses, all four website use variables were positively associated with increased knowledge (p’s < 0.05). Complete VCT use and number of informational sections were positively associated with greater decisional satisfaction (p’s < 0.05). Decisional conflict and screening behavior were not associated with measures of website use. Increased use of informational content and interactive elements were related to improved knowledge and satisfaction. Methods to increase utilization of interactive website components may improve informed decision-making outcomes.
Similar content being viewed by others
References
Andriole GL, Crawford ED, Grubb RL III, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009; 360(13): 1310-1319.
Andriole GL, Crawford ED, Grubb RL III, et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012; 104(2): 125-132.
Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009; 360(13): 1320-1328.
Schroder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med. 2012; 366(11): 981-990.
Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUA guideline. J Urol. 2013; 190: 419-426.
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(2): 88-105.
Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010; 60(2): 70-98.
Moyer VA. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157(2): 120-134.
Gigerenzer G, Mata J, Frank R. Public knowledge of benefits of breast and prostate cancer screening in Europe. J Natl Cancer Inst. 2009; 101(17): 1216-1220.
Hoffman RM, Couper MP, Zikmund-Fisher BJ, et al. Prostate cancer screening decisions: results from the National Survey of Medical Decisions (DECISIONS study). Arch Intern Med. 2009; 169(17): 1611-1618.
O’Connor AM, Stacey D, Rovner D, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2001;(3):CD001431.
O’Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood). 2004;Suppl Variation:VAR63–VAR72.
PEW Internet & American Life Project. Generations 2010. Available at http://www.pewinternet.org/2010/12/16/generations-2010/. Accessed 3 April 2014.
Ritterband LM, Thorndike FP, Cox DJ, Kovatchev BP, Gonder-Frederick LA. A behavior change model for internet interventions. Ann Behav Med. 2009; 38(1): 18-27.
Ilic D, Risbridger GP, Green S. The informed man: attitudes and information needs on prostate cancer screening. J Mens Health Gend. 2005; 2(4): 414-420.
Ilic D, Murphy K, Green S. Perspectives on knowledge, information seeking and decision-making behaviour about prostate cancer among Australian men. J Mens Health. 2013. doi:10.1016/j.jomh.2012.10.004.
Lawrentschuk N, Abouassaly R, Hackett N, Groll R, Fleshner NE. Health information quality on the internet in urological oncology: a multilingual longitudinal evaluation. Urol. 2009; 74(5): 1058-1063.
Taylor KL, Davis KM, Lamond T, et al. Use and evaluation of a CD-ROM-based decision aid for prostate cancer treatment decisions. Behav Med. 2010; 36(4): 130-140.
PEW Internet & American Life Project. Online Health Search 2006. Available at http://www.pewinternet.org/Reports/2006/Online-Health-Search-2006.aspx. Accessed 3 April 2014.
Couper MP, Singer E, Levin CA, Fowler FJ Jr, Fagerlin A, Zikmund-Fisher BJ. Use of the Internet and ratings of information sources for medical decisions: results from the DECISIONS survey. Med Decis Mak. 2010; 30(5 Suppl): 106S-114S.
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 Intern Med. 2013; 173(18): 1704-1712.
Allen JD, Othus MK, Hart A Jr, et al. A randomized trial of a computer-tailored decision aid to improve prostate cancer screening decisions: results from the take the wheel trial. Cancer Epidemiol Biomarkers Prev. 2010; 19(9): 2172-2186.
Evans R, Joseph-Williams N, Edwards A, et al. Supporting informed decision making for prostate specific antigen (PSA) testing on the web: an online randomized controlled trial. J Med Internet Res. 2010; 12(3): e27.
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(10): 781-787.
Frosch DL, Bhatnagar V, Tally S, Hamori CJ, Kaplan RM. Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening. Arch Intern Med. 2008; 168(4): 363-369.
Ilic D, Egberts K, McKenzie JE, Risbridger G, Green S. Informing men about prostate cancer screening: a randomized controlled trial of patient education materials. J Gen Intern Med. 2008; 23(4): 466-471.
Krist AH, Woolf SH, Johnson RE, Kerns JW. Patient education on prostate cancer screening and involvement in decision making. Ann Fam Med. 2007; 5(2): 112-119.
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(3): 482-489.
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(6): 677-697.
Legare F, O’Connor AM, Graham ID, et al. Primary health care professionals’ views on barriers and facilitators to the implementation of the Ottawa Decision Support Framework in practice. Patient Educ Couns. 2006; 63(3): 380-390.
Feldman-Stewart D, Tong C, Siemens R, et al. The impact of explicit values clarification exercises in a patient decision aid emerges after the decision is actually made: evidence from a randomized controlled trial. Med Decis Mak. 2012; 32(4): 616-626.
Gustafson DH, Hawkins R, McTavish F, et al. Internet-based interactive support for cancer patients: are integrated systems better? J Commun. 2008; 58(2): 238-257.
Jibaja-Weiss ML, Volk RJ, Granchi TS, et al. Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy. Patient Educ Couns. 2011; 84(1): 41-48.
Richardson A, Graham AL, Cobb N, et al. Engagement promotes abstinence in a web-based cessation intervention: cohort study. J Med Internet Res. 2013; 15(1): e14.
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 Inform Decis Mak. 2010; 10: 12.
Elwyn G, O’Connor A, Stacey D, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006; 333(7565): 417.
Friedman DB, Hoffman-Goetz L. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav. 2006; 33(3): 352-373.
Gattellari M, Ward JE. Does evidence-based information about screening for prostate cancer enhance consumer decision-making? A randomised controlled trial. J Med Screen. 2003; 10(1): 27-39.
Holmes-Rovner M, Kroll J, Schmitt N, et al. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Mak. 1996; 16(1): 58-64.
O’Connor AM. User Manual—Decisional Conflict Scale. 1993 [updated 2010]. Available at http://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Decisional_Conflict.pdf. Accessed 3 April 2014.
Wilkes MS, Day FC, Srinivasan M, et al. Pairing physician education with patient activation to improve shared decisions in prostate cancer screening: a cluster randomized controlled trial. Ann Fam Med. 2013; 11(4): 324-334.
Eng TR, Gustafson DH. Wired for Health and Well-Being: the Emergence of Interactive Health Communication. Washington: Science Panel on Interactive Communication and Health, U.S. Department of Health and Human Services, U.S. Government Printing Office; 1999.
Sheridan SL, Griffith JM, Behrend L, Gizlice Z, Jianwen C, Pignone MP. Effect of adding a values clarification exercise to a decision aid on heart disease prevention: a randomized trial. Med Decis Mak. 2010; 30(4): E28-E39.
Kreps GL, Neuhauser L. New directions in eHealth communication: opportunities and challenges. Patient Educ Couns. 2010; 78(3): 329-336.
Acknowledgments
The authors thank the participants for their time spent participating in this study and thank Susan Marx for her administrative support. This was an investigator-initiated study funded by The National Cancer Institute (grant # R01 CA119168-01), Department of Defense (grant # PC051100). Additional support was provided by the Lombardi Comprehensive Cancer Center Biostatistics and Bioinformatics Shared Resource and the LCCC Cancer Center Support Grant. The funders played no role in the design, conduct, or analysis of the study, nor in the interpretation and reporting of the study findings. The researchers were independent from the funders. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards
CT, KD, SL, AS, SK, GL, and KLT declare that they have no conflicts of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
Funding
The National Cancer Institute (Grant # R01 CA119168-01), Department of Defense (Grant # 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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Implications
Practice: Clinicians should encourage the use of web-based decision aids to help patients become aware of the facts associated with medical tests and treatments and to aid informed decision making.
Policy: Web-based decision aids are a relatively inexpensive way to make a significant impact on decision-making outcomes among a large number of patients.
Research: Further research is needed to assess whether interactive components of websites play a key role in increasing patient engagement and in improving decision-making outcomes
Earlier versions of the results were presented at the 36th annual meeting of the American Society of Preventive Oncology, Washington, DC, March 2012.
About this article
Cite this article
Tomko, C., Davis, K., Ludin, S. et al. Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening. Behav. Med. Pract. Policy Res. 5, 189–197 (2015). https://doi.org/10.1007/s13142-014-0301-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13142-014-0301-0