PSA AND COLON CANCER SCREENING - EVIDENCE OF DECISION QUALITY WHEN DECISION AIDS ARE USED

Purpose: One of the International Patient Decision Aid Standards (IPDAS) criteria indicates an effective decision aid should improve decision quality (i.e., “the match between the chosen option and features that matter most to the informed patient”). Our objective was to determine if decision aids could improve decision quality for patients choosing to get screened for prostate or colon cancer.

Methods: From January 2006 – May 2008, eligible patients systematically received a video decision aid to help them with decisions about PSA testing and colon cancer screening (CRC).  Participants: 1) complete a pre-DA questionnaire, 2) watch a condition-specific video decision aid, and 3) complete a post-DA questionnaire.  Measures: pre/post-video screening intention, knowledge of key facts, patient values scores (category scale: 1-10 importance). A chart review was conducted to determine if patients followed through with their decisions.

Results: After watching the video decision aid: 1) most patients demonstrated an understanding of key facts associated with the screening decision (average knowledge score: PSA 93%, CRC 78%),     2) a substantial proportion of patients changed their screening intention (PSA: 24%, CRC 30%), and 3) more patients chose the screening option predicted by their values scores (p ≤ .05).  Patients who felt it was more important to “Know if you have cancer” and “Find cancer early” were more likely to opt for screening (p ≤ .05).  Patients watching the PSA DA were less likely to opt for screening, while those watching the CRC DA were more likely to choose screening (p ≤ .05).  Patients indicating they would get screened were more likely to do so.

Conclusions: For these patients, decision aids appear to improve decision quality by helping them choose the screening option that is concordant with the values that are more important to them.  These results suggest that when patients are provided information regarding the risks and benefits of cancer screening, they are likely to follow through with their choice.

Intention after DA	N	Got screened N (row %)
PSA Screening	214	173 (81)
No PSA screening	150	47 (32)
Unsure	64	42 (65)
TOTAL	428	262 (61)
CRC Screening	39	27 (69)
No CRC Screening	13	5 (38)
Unsure	6	3 (50)
TOTAL	58	35 (60)