Does 'peer coaching' increase GP capacity to promote informed decision making about PSA screening? A cluster randomised trial.
BACKGROUND
Very little effort has been directed to enable GPs to better informed decisions about PSA screening among their male patients.


OBJECTIVE
To evaluate an innovative programme designed to enhance GPs' capacity to promote informed decision making by male patients about PSA screening.


METHODS
The study design was a cluster randomised controlled trial set in New South Wales, Australia's most populous state. 277 GPs were recruited through a major pathology laboratory. The interventions were three telephone-administered 'peer coaching' sessions integrated with educational resources for GPs and patients and the main outcome measures were: GP knowledge; perceptions of patient involvement in informed decision making; GPs' own decisional conflict; and perceptions of medicolegal risk.


RESULTS
Compared with GPs allocated to the control group, GPs allocated to our intervention gained significantly greater knowledge about PSA screening and related information [Mean 6.1 out of 7; 95% confidence interval (CI) = 5.9-6.3 versus 4.8; 95% CI = 4.6-5.0; P < 0.001]. They were less likely to agree that patients should remain passive when making decisions about PSA screening [Odds ratio (OR) = 0.11; 95% CI = 0.04-0.31; P < 0.001]. They perceived less medicolegal risk when not acceding to an 'uninformed' patient request for a PSA test (OR = 0.31; 95% CI 0.19-0.51). They also demonstrated lower levels of personal decisional conflict about the PSA screening (Mean 25.4; 95% CI 24.5-26.3 versus 27.8; 95% CI 26.6-29.0; P = 0.0002).


CONCLUSIONS
A 'peer coaching' programme, supplemented by education materials, holds promise as a strategy to equip GPs to facilitate informed decision making amongst their patients.
Gattellari
Melina
M
School of Public Health and Community Medicine, University of New South Wales and Centre for Research, Evidence Management and Serveillance, South Western Sydney Area Health Service, Liverpool, NSW 1871, Australia. Melina.Gattellari@swsahs.nsw.gov.au
Donnelly
Neil
N
Taylor
Nicholas
N
Meerkin
Matthew
M
Hirst
Geoffrey
G
Ward
Jeanette E
JE
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003376:Counseling / Q000706:statistics & numerical data; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education* / Q000592:standards; D005246:Feedback; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D018024:Peer Review, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000201:enzymology
D017430:Prostate-Specific Antigen