Methods: A 30 minute video decision aid on PSA screening for prostate cancer was given to eligible men aged 50-80 seeing “early adopter” clinicians at two academic general internal medicine outpatient clinics (Dartmouth-Hitchcock Medical Center, Lebanon, NH and White River Junction VAMC, VT). To assess the best time for patients to view the decision aid, we conducted 2 pilots: 1) patients viewed the video after their visit, and 2) before the visit. Patients completed surveys assessing knowledge, values and preferences regarding screening before and after viewing the video. Satisfaction with the video was assessed after viewing. Clinicians completed a survey at the end of the pilot.
Results: Eighty patients viewed the video after their visit, and 29 viewed it before the visit. Patient satisfaction with the video was high, with the large majority finding the video clear, balanced, and helpful. After viewing the video, knowledge scores (% answering >1/3 questions correctly) increased from 11% to 75%. Patients' perceived value of finding prostate cancer early and knowing whether or not cancer was present decreased significantly (p=.0002, p=.00001). Fourteen percent of patients felt the video changed their decision to get the PSA test; with a trend toward more patients preferring no screening (p=.11). Patients had a clear preference for either taking the lead role in decision making or sharing the decision with their clinician (as opposed to a clinician led decision), and viewing the video increased preference for a patient led decision. Ten of 11 clinicians felt that the PSA video is best viewed before the visit. Ninety four percent of patients viewing the video before the visit felt it helped them better communicate with their provider during the visit. However, the video before visit model was associated with more logistical challenges and a drop in the recruitment of eligible patients from 75% to 56%.
Conclusions: A PSA video decision aid can facilitate shared decision making in primary care and is well accepted by patients. Although more challenging to implement, viewing the video before the visit has advantages and is preferred by clinicians.