Supporting informed decision making online in 20 minutes: an observational web-log study of a PSA test decision aid.
BACKGROUND
Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this relates to the informed decision making outcome measures.


OBJECTIVE
To examine men's use of an online decision aid for prostate cancer screening using website transaction log files (web-logs), and to examine associations between usage and components of informed decision making.


METHODS
We conducted an observational web-log analysis of users of an online decision aid, Prosdex. Men between 50 and 75 years of age were recruited for an associated RCT from 26 general practices across South Wales, United Kingdom. Men allocated to one arm of the RCT were included in the current study. Time and usage data were derived from website log files. Components of informed decision making were measured by an online questionnaire.


RESULTS
Available for analysis were 82 web-logs. Overall, there was large variation in the use of Prosdex. The mean total time spent on the site was 20 minutes. The mean number of pages accessed was 32 (SD 21) out of a possible 60 pages. Significant associations were found between increased usage and increased knowledge (Spearman rank correlation [rho] = 0.69, P < .01), between increased usage and less favorable attitude towards PSA testing (rho = -0.52, P < .01), and between increased usage and reduced intention to undergo PSA testing (rho = -0.44, P < .01). A bimodal distribution identified two types of user: low access and high access users.


CONCLUSIONS
Increased usage of Prosdex leads to more informed decision making, the key aim of the UK Prostate Cancer Risk Management Programme. However, developers realistically have roughly 20 minutes to provide useful information that will support informed decision making when the patient uses a web-based interface. Future decision aids need to be developed with this limitation in mind. We recommend that web-log analysis should be an integral part of online decision aid development and analysis.


BACKGROUND
ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5pqeF89tS).
Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom. josephnj1@cf.ac.uk
Natalie
N
Joseph-Williams
Rhodri
R
Evans
Adrian
A
Edwards
Robert G
RG
Newcombe
Patricia
P
Wright
Richard
R
Grol
Glyn
G
Elwyn
D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009862:Online Systems; D010353:Patient Education as Topic / Q000379:methods*; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D012308:Risk Management / Q000379:methods; D012984:Software; D011795:Surveys and Questionnaires
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen