title: Pairing physician education with patient activation to improve shared decisions in prostate cancer screening: a cluster randomized controlled trial.
abstract: BACKGROUND
  Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations.
  
  
  METHODS
  Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Web-based educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening.
  
  
  RESULTS
  Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control=38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A=50%, MD-Ed=33%, control=15%; P <.05). Of the male patients, 80% had had previous PSA tests.
  
  
  CONCLUSIONS
  Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.
authors.affiliation: Office of Dean, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA. mwilkes@ucdavis.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wilkes
authors.forename: Frank C
authors.initials: FC
authors.lastname: Day
authors.forename: Malathi
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Erin
authors.initials: E
authors.lastname: Griffin
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: Julie A
authors.initials: JA
authors.lastname: Rainwater
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Bell
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods*; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D014481:United States / Q000453:epidemiology
keywords: decision making; doctor-patient communication; medical uncertainty; patient activation; patient-centered care; patient-physician relationship; prostate; randomized controlled trial; shared; standardized patient