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Informing men about prostate cancer screening: a randomized controlled trial of patient education materials.

ABSTRACT: BACKGROUND: Patient education materials can assist patient decision making on prostate cancer screening. OBJECTIVE: To explore the effectiveness of presenting health information on prostate cancer screening using video, internet, and written interventions on patient decision making, attitudes, knowledge, and screening interest. DESIGN: Randomized controlled trial. PARTICIPANTS: A total of 161 men aged over 45, who had never been screened for prostate cancer, were randomized to receive information on prostate cancer screening. MEASUREMENTS: Participants were assessed at baseline and 1-week postintervention for decisional conflict, screening interest, knowledge, anxiety, and decision-making preference. RESULTS: A total of 156 men were followed-up at 1-week postintervention. There was no statistical, or clinical, difference in mean change in decisional conflict scores between the 3 intervention groups (video vs internet -0.06 [95% CI -0.24 to 0.12]; video vs pamphlet 0.04 [95%CI -0.15 to 0.22]; internet vs pamphlet 0.10 [95%CI -0.09 to 0.28]). There was also no statistically significant difference in mean knowledge, anxiety, decision-making preference, and screening interest between the 3 intervention groups. CONCLUSION: Results from this study indicate that there are no clinically significant differences in decisional conflict when men are presented health information on prostate cancer screening via video, written materials, or the internet. Given the equivalence of the 3 methods, other factors need to be considered in deciding which method to use. Health professionals should provide patient health education materials via a method that is most convenient to the patient and their preferred learning style.

SUBMITTER: Ilic D

PROVIDER: S-EPMC2359522 | biostudies-other | 2008 Apr

REPOSITORIES: biostudies-other

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Project description:ContextProstate cancer screening with prostate-specific antigen (PSA) is frequently performed, counter to clinical practice guidelines.BackgroundIt was hypothesized that an e-mail-based intervention termed "spaced education" could reduce clinicians' inappropriate screening for prostate cancer.DesignThe study was conducted as an RCT.Setting/participantsThe study involved 95 primary care clinicians in eight Veterans Affairs medical centers from January 2007 to February 2009.InterventionParticipants were randomized into two cohorts: spaced education clinicians received four isomorphic cycles of nine e-mails over 36 weeks (zero to two e-mails per week), whereas control clinicians received no intervention. Each e-mail presented a clinical scenario and asked whether it was appropriate to obtain a PSA test. Participants received immediate feedback after submitting their answers.Main outcome measuresThe primary outcome was the number and percentage of inappropriate PSA screening tests ordered. Inappropriate testing was defined as use of PSA for prostate cancer screening in patients aged >76 or <40 years. Appropriateness of screening was dichotomized based on patient age at time of screening. Patients with PSA testing for non-screening reasons were excluded using a validated protocol. Logistic regression with adjustment for patient clustering by clinician was performed. Analyses were conducted in 2009.ResultsDuring the intervention period (Weeks 1-36), clinicians receiving spaced education e-mails ordered significantly fewer inappropriate PSA screening tests than control clinicians (10.5% vs 14.2%, p=0.041). Over the 72-week period following the intervention (Weeks 37-108), spaced education clinicians continued to order fewer inappropriate tests compared to controls (7.8% vs 13.1%, respectively, p=0.011), representing a 40% relative reduction in inappropriate screening.ConclusionsSpaced education durably improves the prostate cancer screening behaviors of clinicians and represents a promising new methodology to improve patient care across healthcare systems.

Project description:ImportanceTo make good decisions about prostate-specific antigen (PSA) screening, men must consider how they value the different potential outcomes.ObjectiveTo determine the effects of different methods of helping men consider such values.Design and settingRandomized trial from October 12 to 27, 2011, in the general community.ParticipantsA total of 911 men aged 50 to 70 years from the United States and Australia who had average risk. Participants were drawn from online panels from a survey research firm in each country and were randomized by the survey firm to 1 of 3 values clarification methods: a balance sheet (n = 302), a rating and ranking task (n = 307), or a discrete choice experiment (n = 302).InterventionParticipants underwent a values clarification task and then chose the most important attribute.Main outcome measuresThe main outcome was the difference among groups in the most important attribute. Secondary outcomes were differences in unlabeled test preference and intent to undergo screening with PSA.ResultsThe mean age was 59.8 years; most participants were white and more than one-third had graduated from college. More than 40% reported a PSA test within 12 months. The participants who received the rating and ranking task were more likely to report reducing the chance of death from prostate cancer as being most important (54.4%) compared with those who received the balance sheet (35.1%) or the discrete choice experiment (32.5%) (P < .001). Those receiving the balance sheet were more likely (43.7%) to prefer the unlabeled PSA-like option (as opposed to the "no screening"-like option) compared with those who received rating and ranking (34.2%) or the discrete choice experiment (20.2%). However, the proportion who intended to undergo PSA testing was high and did not differ between groups (balance sheet, 77.1%; rating and ranking, 76.8%; and discrete choice experiment, 73.5%; P = .73).Conclusions and relevanceDifferent values clarification methods produce different patterns of attribute importance and different preferences for screening when presented with an unlabeled choice. Further studies with more distal outcome measures are needed to determine the best method of values clarification, if any, for decisions such as whether to undergo screening with PSA.

Project description:OBJECTIVE:The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice. METHODS:A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored. RESULTS:A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated. CONCLUSION:The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.

Project description:BackgroundPhysical activity has been shown to mitigate the unwanted psychological and physiological side effects of prostate cancer treatments, but sustainable exercise possibilities are limited.ObjectiveOur objective was to examine whether football in a real-world setting (i.e., local football clubs) was safe and feasible in practice and could improve quality of life, mitigate decline in muscle mass and bone density, and increase fat mass in patients with prostate cancer.MethodsIn this pragmatic, multicentre, parallel randomized controlled trial, men diagnosed with prostate cancer were recruited from five Danish urological departments. Men (N = 214) diagnosed with prostate cancer were randomly allocated, using random generated lists (block size 4-8) stratified for center and androgen-deprivation therapy status, to either 1 h of football twice weekly in a local football club or to usual care, which was a 15- to 30-min telephone session covering their options for physical activity or free-of-charge rehabilitation delivered as standard in Denmark. Allocation was concealed from the trial investigator performing the randomization, but-given the nature of the intervention-this was not possible for personnel and participants. Assessments were performed at baseline, 12 weeks, and 6 months. The primary outcome was mean change difference in prostate cancer-specific quality of life at 12 weeks. Secondary outcomes were body composition, 12-Item Short Form Health Survey (SF-12) physical and mental health, and safety-reported as fractures, falls, and serious adverse events.ResultsAttrition was 1 and 3% at 12 weeks, and 5% and 5% at 6 months for the usual care and football groups, respectively. Prostate cancer-specific quality of life was equal between groups at 12 weeks (mean difference + 1.9 points, 95% confidence interval [CI] -1.0-4.8; P = 0.20) and at 6 months (+ 0.5 points, 95% CI -2.8-3.8; P = 0.76). Fractures were equally distributed, with two fractures in the usual care group and one in the football group. Likewise, body composition outcomes were equal. Mental health improved after 6 months of football (mean difference + 2.7 points, 95% CI 0.8-4.6; P = 0.006).ConclusionsIn this trial, community-based football was a feasible exercise strategy for men with prostate cancer. Football did not improve prostate cancer-specific quality of life but did improve mental health; the clinical significance of this is unclear.Trial registrationClinicalTrials.gov: NCT02430792.

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Informing men about prostate cancer screening: a randomized controlled trial of patient education materials.

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