USE OF PATIENT DECISION AIDS IN ROUTINE CARE: WHAT IMPACT DOES IT HAVE ON DECISION MAKING ABOUT PROSTATE CANCER SCREENING?

Purpose:

Decision aids (DA) have been shown to increase patients’ knowledge and involvement in treatment decisions, and reduce decisional conflict in randomized controlled trials. However, less is known about the impact of these tools in routine care. The aim of this study was to assess the effectiveness of a prostate cancer screening DA when used in primary care.

Method:

All providers in the 18 primary care practices affiliated with Massachusetts General Hospital are able to order DAs through the electronic medical record. The DA is then mailed to the patient. A questionnaire was sent with all prostate cancer screening (PSA) DAs that asked about knowledge, goals, and screening intentions before and after watching the program.

Result:

From March 2010-November 2013, 2,588 PSA DAs were mailed and 616 completed questionnaires (response rate 23.8%) were received. The respondents were 83.4% White, mean age 58.4 years old (SD 8.1 years), and 55.3% reported a college education or more. Most respondents watched all or most of the program (75.8%), slightly fewer read all or most of the booklet (60.4%).

Respondents’ mean knowledge score was 89.4%, (SD 21.7%). A majority understood that most men with prostate cancer die of something other than prostate cancer (84.4%). Most respondents found the DA very or extremely useful in helping them understand what a PSA test is (77.5%), deciding whether or not to have a PSA test (78.2%), and preparing to talk with their provider about the PSA test (71.3%).

After viewing the DA, fewer men remained unsure about testing (33.6% pre-viewing vs. 17% post viewing, p≤.001) and more men did not intend to have a PSA test (32% pre-viewing vs. 51% post viewing, p<0.001). Men who were leaning toward having a PSA test felt it was more important to find cancer early (8.4 vs. 5.0 out of 10, p<0.001) and to have peace of mind from a negative result (8.2 vs. 4.9 out of 10, p<0.001) compared to men who were leaning toward not having PSA test.

Conclusion:

The use of the DA in routine care helped men clarify preferences about PSA test, be well informed, and prepare to discuss PSA screening with primary care providers. These results provide evidence of the effectiveness of DAs in supporting shared decision making in clinical practice.