Men's Health

Prostate cancer screening decision aids lead to greater knowledge and involvement in decisionmaking by patients and lower screening rates

The uncertainty about the ability of prostate-specific antigen (PSA) screening to reduce prostate cancer mortality has led professional organizations to offer guidelines promoting informed decisionmaking about prostate cancer screening. Decision aids help people make choices among options by providing information on the options and outcomes relevant to a patient's health status.

The authors of this article systematically reviewed studies evaluating decision aids for PSA screening to determine their impact on men's decisions to be screened. Of the 357 studies initially selected for review, 18 were considered eligible, and only 12 were rated as good quality studies. The types of decision aids considered were:

• A videotape, "The PSA Decision: What You Need to Know" (versions of which were used in eight of the studies).
• Discussion sessions.
• Written materials, often with illustrations.
• Written materials combined with education sessions.
• Internet-based materials.

Decision aids were delivered in one of four contexts: men visiting urology clinics specifically for screening, primary care patients before scheduled visits, primary care patients on clinic rosters without a scheduled visit, and nonpatients in community settings. The most common outcome measured was knowledge of prostate cancer screening.

Men who used decision aids had significantly higher knowledge scores than men without decision aids. In the 10 studies where actual screening rates were measured, there was a broad range of screening rates. For example, among men using decision aids, the PSA screening rate varied from a low of about 12 percent (among men making scheduled visits) to a high of 98 percent (among men attending a free-screening clinic). The screening rates for men without decision aids ranged from 21 percent to 100 percent. Among patients seeking routine care, prostate cancer screening decision aids appeared to decrease interest in screening, the intention to be screened, and PSA screening rates. However, for patients seeking screening services, the decision aids had no impact on their screening behavior.

In light of public enthusiasm for cancer screening, the researchers were surprised that prostate cancer screening decision aids received by the patients led some of them to question the value of screening and decide against it. This study was sponsored in part by the Agency for Healthcare Research and Quality (HS10612).

See "Trials of decision aids for prostate cancer screening: a systematic review," by Robert J. Volk, Ph.D., Sarah T. Hawley, Ph.D., Suzanne Kneuper, M.A., and others in the American Journal of Preventive Medicine 33(5), pp. 428-434, 2007.

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