Abstract
OBJECTIVE: California law (Grant H. Kenyon Prostate Cancer Detection Act) requires physicians to inform all patients older than aged 50 years who receive a prostate examination about the availability of the prostate-specific antigen (PSA) test. Physicians are not given guidance on how this information should be presented. We sought to evaluate the effects upon PSA screening rates of informing patients about PSA testing by 2 different techniques.
DESIGN: Factorial comparison of discussion versus video formats for presenting information about the PSA test.
SETTING: Patients were recruited through the Health Appraisal screening program in the Department of Preventive Medicine, Kaiser Permanente, San Diego, Calif.
PARTICIPANTS: Male patients undergoing health appraisal screening participated in 1 of 4 groups providing information about PSA screening: usual care (n=43), discussion about risks and benefits of PSA (n=45), shared decision-making video (n=46), or video plus discussion (n=42). Participants were sequentially assigned to 1 of the 4 groups.
RESULTS: No significant differences in demographics or family history was demonstrated between the groups at the time of group assignment. Participants in the intervention groups rated the information as clear, balanced, and fair. There were significant differences in the number of men requesting a PSA test, with the highest rate in the usual care group (97.7%), followed by discussion (82.2%), video (60.0%), and video plus discussion (50.0%).
CONCLUSION: Providing information about PSA screening in the form of video or discussion is feasible and significantly alters PSA screening rates.
Similar content being viewed by others
References
Boyle P. Prostate-specific antigen (PSA) testing as screening for prostate cancer: the current controversy. Ann Oncol. 1998;9:1263–4.
Barry MJ. PSA screening for prostate cancer: the current controversy — a viewpoint. Ann Oncol. 1998;9:1279–82.
Johansson JE, Holmberg L, Johansson S, Bergström R, Adami HO. Fifteen-year survival in prostate cancer. A prospective, population-based study in Sweden. JAMA. 1997;277:467–71.
The American Urological Association Prostate Cancer Clinical Guidelines Panel. Report on the Management of Clinically Localized Prostate Cancer. Baltimore, Md: American Urological Association Inc; 1995.
American Cancer Society Prostate Cancer Screening Guidelines. Cancer Facts and Figures 1997. Atlanta, Ga: American Cancer Society; 1997.
Executive Committee Report: Early Detection of Prostate Cancer. Baltimore, Md: American Urologic Association; 1997.
Kaplan RM. Shared medical decision-making: a new paradigm for behavioral medicine. Ann Behav Med. 1999;21:3–11.
Frosch DL, Kaplan RM. Shared decision-making in clinical medicine: past research and future directions. Am J Prev Med. 1999;17:285–94.
Flood AB, Wennberg JE, Nease RF, Fowler FJ, Ding J, Hynes LM. The importance of patient preference in the decision to screen for prostate cancer. Prostate Patient Outcomes Research Team. J Gen Intern Med. 1996;11:342–9.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
Maxwell SE. Designing Experiments and Analyzing Data: A Model Comparison Perspective. Belmont, Calif: Wadsworth Publishers; 1990.
Wolf AM, Nasser JF, Wolf AM, Schorling JB. The impact of informed consent on patient interest in prostate-specific antigen screening. Arch Intern Med. 1996;156:1333–6.
Volk RJ, Cass AR, Spann SJ. A randomized controlled trial of shared decision making for prostate cancer screening. Arch Fam Med. 1999;8:333–40.
Barry MJ, Fowler FJ, Mulley AG, Henderson JV, Wennberg JE. Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Med Care. 1995;33:771–82.
Dartmouth Medical School, Center for the Evaluative Clinical Sciences. The Dartmouth Atlas of Health Care 1998. Dartmouth: American Hospital Association; 1998.
Morgan MW, Deber RB, Llewellyn-Thomas HA, et al. Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease. J Gen Intern Med. 2000;15:685–93.
Kasper JF, Mulley AG, Wennberg JE. Developing shared decision-making programs to improve the quality of health care. QRB Qual Rev Bull. 1992;18:183–90.
Man-Son-Hing M, Laupacis A, O’Connor AM, et al. Development of a decision aid for patients with atrial fibrillation who are considering antithrombotic therapy. J Gen Intern Med. 2000;15:723–30.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported in part by grant TPRH-98-119-01 from the American Cancer Society. Gratitude is expressed to Kathy Peterman, Donna Lupinacci, Kathy Jakstis, and the staff at Health Appraisal Clinic, Kaiser Permanente, San Diego, without whom this study would not have been possible.
Rights and permissions
About this article
Cite this article
Frosch, D.L., Kaplan, R.M. & Felitti, V. Evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test. J GEN INTERN MED 16, 391–398 (2001). https://doi.org/10.1046/j.1525-1497.2001.016006391.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2001.016006391.x