Purpose: Informed decision making (IDM) about prostate cancer screening is limited in primary care practice settings. This study aimed to assess IDM and the impact of an in-person decision counseling intervention on IDM in physician-patient encounters.
Method: Physicians in two primary care practices completed a self-administered baseline survey. Asymptomatic men who were 50-69 years of age, were eligible for prostate cancer screening, and had a scheduled office visit for non-acute care completed a baseline telephone survey. Both surveys assessed personal background characteristics, knowledge, and perceptions about prostate cancer screening. All participating patients were sent a brochure on prostate cancer screening before their scheduled office visit. At the visit, participants were randomized either to an enhanced intervention (EI) or a standard intervention (SI) group. SI Group men met with a nurse educator and completed a practice satisfaction survey; while EI Group men met with a nurse educator to review the prostate brochure, identify and weight personal values related to screening, and clarify screening preference via a values comparison exercise. A physician prompt to discuss screening was placed on the medical chart of all participants. Subsequent physician-patient encounters were audio-recorded and coded. A completeness of IDM score, based on the number of screening issues (0-9) discussed, was computed. Negative binomial regression was used to identify IDM predictors.
Result: In 144 physician-patient encounters, IDM scores were low (mean = 2.9, std. dev. = 2.1). Positive patient predictors of IDM included exposure to decision counseling (p = 0.029), being African American (p = 0.031), belief that susceptibility to prostate cancer is low (p = 0.027), and worry about screening (p = 0.038). Positive physician predictors of IDM were years in practice (p = 0.001), awareness that screening is controversial (p = 0.009), and confidence in approach used to discuss screening with patients (p = 0.01), although these associations did not follow a clear monotonic pattern.
Conclusion: Decision counseling, along with patient and physician characteristics, influenced prostate cancer screening IDM. Research is needed to determine how to maximize the impact of this type of intervention in clinical interactions and on decision making in diverse populations.
Candidate for the Lee B. Lusted Student Prize Competition