Mediated decision support in prostate cancer screening: a randomized controlled trial of decision counseling.
OBJECTIVE
This randomized trial was conducted to assess the impact of a mediated decision support intervention on primary care patient prostate cancer screening knowledge, decisional conflict, informed decision making (IDM), and screening.


METHODS
Before a routine office visit, 313 male patients eligible for prostate cancer screening completed a baseline telephone survey and received a mailed brochure on prostate cancer screening. At the visit, participants were randomized to either an enhanced intervention (EI) or a standard intervention (SI) group. Before meeting with their physician, EI Group men had a nurse-led "decision counseling" session, while SI Group men completed a practice satisfaction survey. An endpoint survey was administered. Survey data, encounter audio-recordings, and chart audit data were used to assess study outcomes.


RESULTS
Knowledge increased in the EI Group (mean difference of +0.8 on a 10-point scale, p=0.001), but decisional conflict did not change (mean difference of -0.02 on a 4-point scale, p=0.620). The EI Group had higher IDM (rate ratio=1.30, p=0.029) and lower screening (odds ratio=0.67, p=0.102).


CONCLUSIONS
Nurse-mediated decision counseling increased participant prostate cancer screening knowledge, and influenced informed decision making and screening.


CONCLUSIONS
Nurses trained in decision counseling can facilitate shared decision making about screening.
Myers
Ronald E
RE
Thomas Jefferson University, USA. Ronald.Myers@jefferson.edu
Daskalakis
Constantine
C
Kunkel
Elisabeth J S
EJ
Cocroft
James R
JR
Riggio
Jeffrey M
JM
Capkin
Mark
M
Braddock
Clarence H
CH
D000328:Adult; D000368:Aged; D003142:Communication; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000295:instrumentation / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D015999:Multivariate Analysis; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D012944:Social Support; D013637:Tape Recording