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Wednesday, 18 October 2006 - 11:45 AM


Dominick Frosch, PhD, UCLA, Los Angeles, CA, Vibha Bhatnagar, MD, MPH, University of California San Diego and VA San Diego Healthcare System, San Diego, CA, Steven Tally, PhD, University of California San Diego, La Jolla, CA, and Robert M. Kaplan, PhD, University of California Los Angeles, Los Angeles, CA.

Purpose: Few studies have rigorously evaluated patient decision support delivered through the Internet. We conducted a randomized controlled trial comparing alternative Internet decision support tools for men considering prostate cancer screening.

Methods: Men over 50 years (N=603) scheduled for a preventive physical examination were recruited and randomly assigned to one of four Internet tools prior to their appointment: a didactic decision aid providing information about PSA screening (Group 1); a decision aid using a chronic illness trajectory model for prostate cancer followed by a one item visual analog and time trade-off exercise (Group 2); both the didactic decision aid and the chronic illness trajectory (Group 3); or links to reputable public prostate cancer information websites (Center for Disease Control and American Cancer Society; Group 4). Participants completed questionnaires before and after their physical exam. Primary dependent measures were knowledge about prostate cancer, decisional conflict, PSA test choice and prostate cancer treatment preferences.

Results: There were no baseline differences between groups: average age was 59 years (SD = 5.4); the majority were Caucasian (86.1%), married (77.9%) and college educated (70.5%). Participants assigned to view public websites (n= 150) were significantly less likely to review information (76.7% reviewed) than those assigned to the didactic decision aid (n=155; 84.5% reviewed), the chronic illness trajectory decision aid (n=152; 86.2% reviewed) or the combination condition (n=146; 87.7% reviewed; p<.05). At the follow-up evaluation, knowledge scores were significantly lower among those randomized to review public websites, compared to all other groups (p<.001). Participants randomized to Groups 1 and 3 were more likely to feel that they knew the risks of prostate cancer screening (p<.001), knew how important these risks were to them (p<.001) and felt like they made an informed choice (p<.004). There was an overall reduction in preferences for PSA screening from pre- to post-test (p<.001), but no significant group differences in the rates at which men chose PSA screening. Men assigned to review public websites were less likely to indicate a treatment preference for watchful waiting (p<.03).

Conclusion: Public websites about prostate cancer provide less effective decision support than specially designed decision aids. Didactic decision aids lowered decisional conflict compared the chronic illness trajectory decision aid; however, screening decisions and treatment preferences were similar among the three experimental conditions.

See more of Concurrent Abstracts K: Advancing Decision Support in Medical Decision Making
See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)