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Purpose: This study assessed the effects of mailed video and pamphlet prostate cancer (CaP) screening educational interventions on patient decisional involvement, certainty, and satisfaction.
Methods: The study design was a randomized, controlled trial. A sample of 1152 male veterans age 50 and older with no CaP and scheduled primary care appointments at one of four participating Veterans Affairs medical facilities in 2001, stratified by age (50-69, 70+), PSA in the past year (yes, no), and facility, was randomly assigned to one of three study groups: (1) mailed pamphlet, (2) mailed video, or (3) usual care (control). Intervention materials were mailed to patients two weeks prior to their scheduled primary care appointment, and outcomes were assessed by telephone survey approximately one week after the primary care appointment. A total of 42 participants were excluded from the study (8 deceased, 5 females, 29 CaP diagnoses). A total of 893 of the remaining 1110 participants completed the survey (80% response rate) and were included in analyses. Outcomes examined using adjusted linear regression models included: (1) the 13-item Patient Perceptions of Involvement in Care Scale (PICS), (2) Oconnor’s 10-item Factors Contributing to Decisional Uncertainty Scale, and (3) Holmes-Rovner’s 6-item Satisfaction with Decision scale.
Results: Roughly 56% of video and 50% of pamphlet subjects reported looking at the mailed materials. Intent to treat analyses revealed that both video and pamphlet subjects had significantly lower Factors Contributing to Uncertainty scale scores than controls (23.8, 23.8 and 24.5, respectively). Pamphlet subjects were significantly more likely than controls to be involved in CaP decision making (PICS scores 1.73 and 1.20, respectively, p=.05) but video subjects were not (PICs score 1.53, p=.21). Neither intervention increased the generally high levels of satisfaction with decision-making (Satisfaction with Decision scale scores 18.5, 18.3 and 18.3 for video, pamphlet, and control subjects, respectively).
Conclusions: The interventions have modest effects on decisional uncertainty and involvement, and no affect on satisfaction. The slightly more pronounced effects of the pamphlet on decision-making involvement may make it an attractive low cost strategy for busy practice settings searching for ways to facilitate patient participation in CaP screening decisions. The impact of the interventions may be enhanced by increasing patient exposure to the intervention material and enhancing provider facilitation of CaP screening decisions.
See more of Poster Session - Clinical Strategies; Judgment and Decison Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)