Prostate cancer screening decision aids don’t change men’s minds

Men who receive decision aids about prostate cancer screening appear to have significantly increased knowledge about screening and less conflict about what to do, but the decision aids show little impact on their decision whether or not to be screened.

That’s the finding of a new randomized trial published online in JAMA Internal Medicine (July 29, 2013) that examined both web- and print-based tools aimed at helping men make informed decisions about PSA testing.

“The history of conflicting recommendations for prostate cancer screening and the mixed messages about screening effectiveness make it critical to assist men in making informed decisions,” said first author Kathryn Taylor, PhD, of Georgetown Lombardi Comprehensive Cancer Center, Washington.

Dr. Taylor and colleagues developed two decision aids to help men weigh the pros and cons of testing and then make informed decisions about screening. A racially diverse group of 1,879 men aged 45 to 70 years were randomly assigned to utilize a print-based decision aid, an interactive web-based decision aid, or usual care (no decision aid). Telephone interviews were conducted at the start of the study, one month after the start, and again at 13 months to see if the tool had a long-term impact.

“The tools were intended neither to encourage nor discourage screening, but instead to present the benefits and limitations of screening to help men make choices consistent with their preferences,” Dr. Taylor explained.

After the surveys were conducted, the researchers found that both the web-based and print tools increased the men’s knowledge and reduced the initial conflict they reported about whether or not to be screened, and increased their immediate satisfaction with their decision.

“Interestingly, we thought these decision aids might lead to more men forgoing testing, but in fact, the men didn’t change their screening plans,” Dr. Taylor said. “The men told us these tools helped them resolve their own conflicts about whether or not to receive screening.”

The print- and web-based decision aids were found equally effective in improving knowledge and reducing decisional conflict, suggesting that either tool may be used, depending on an individual’s preferred medium, Dr. Taylor says.

“They both have the potential to be easily adopted in real-world practice settings,” she said. “Given the demonstrated beneficial effect of the decision aids, work is now needed to understand the best methods for widespread dissemination.”

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