title: Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations.
abstract: A man's decision to have a prostate-specific antigen (PSA) test should be an informed one. We undertook a systematic review to identify and appraise PSA decision aids and evaluations. We searched 15 electronic databases and hand-searched key journals. We also contacted key authors and organisations. All decision aids and evaluations that discussed PSA were included, with meta-analyses performed on two outcomes from the evaluations: PSA testing and patient knowledge of PSA and related issues. Seven decision aids and 11 evaluations were included. The meta-analysis showed a significantly reduced probability in PSA testing after a decision aid: -3.5% (95% confidence interval: 0.0 to 7.2%; P = 0.050). There were significant improvements in knowledge within 2 weeks after a decision aid: 19.5% (95% confidence interval: 14.2 to 24.8%; P < 0.001). The effect on knowledge was less pronounced within 12-18 months after a decision aid: 3.4% (95% confidence interval: -0.7 to 7.4%; P = 0.10). PSA decision aids improve knowledge about PSA testing, at least in the short term. Men given these decision aids seem to be less likely to have the PSA test.
authors.affiliation: Department of Primary Care, University of Wales Swansea Clinical School, Singleton Park, Swansea SA2 8PP, UK. rhodri.evans@btinterenet.com
authors.forename: Rhodri
authors.initials: R
authors.lastname: Evans
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Joanne
authors.initials: J
authors.lastname: Brett
authors.forename: Mike
authors.initials: M
authors.lastname: Bradburn
authors.forename: Eila
authors.initials: E
authors.lastname: Watson
authors.forename: Joan
authors.initials: J
authors.lastname: Austoker
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010358:Patient Participation; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen