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)