title: Decision making in prostate cancer screening using decision aids vs usual care: a randomized clinical trial.
abstract: OBJECTIVE
  The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions.
  
  
  OBJECTIVE
  To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions.
  
  
  METHODS
  A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures.
  
  
  METHODS
  Random assignment to print-based decision aid (n = 628), web-based interactive decision aid (n = 625), or usual care (UC) (n = 626).
  
  
  METHODS
  Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening.
  
  
  RESULTS
  Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P <.001). At 1 month, the standardized mean difference (Cohen’s d) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC (d = 0.33) and print vs UC (d = 0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P = .009) and significantly more web (P = .001) and print (P = .03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P = .06) and web participants (50.4%; P = .10) were not significant. Screening rates at 13 months did not differ significantly among groups.
  
  
  CONCLUSIONS
  Both decision aids improved participants’ informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00196807.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Taylor
authors.forename: Randi M
authors.initials: RM
authors.lastname: Williams
authors.forename: Kimberly
authors.initials: K
authors.lastname: Davis
authors.forename: George
authors.initials: G
authors.lastname: Luta
authors.forename: Sofiya
authors.initials: S
authors.lastname: Penek
authors.forename: Samantha
authors.initials: S
authors.lastname: Barry
authors.forename: Scott
authors.initials: S
authors.lastname: Kelly
authors.forename: Catherine
authors.initials: C
authors.lastname: Tomko
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Krist
authors.forename: Steven H
authors.initials: SH
authors.lastname: Woolf
authors.forename: Mary B
authors.initials: MB
authors.lastname: Fishman
authors.forename: Carmella
authors.initials: C
authors.lastname: Cole
authors.forename: Edward
authors.initials: E
authors.lastname: Miller
mesh_terms: D000368:Aged; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D020407:Internet; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies
references.citation: Am J Prev Med. 2007 Aug;33(2):83-90
references.pmid: 17673094
references.citation: J Clin Oncol. 2012 Aug 1;30(22):2768-75
references.pmid: 22734029
references.citation: J Med Internet Res. 2010 Aug 06;12(3):e27
references.pmid: 20693148
references.citation: Cochrane Database Syst Rev. 2011 Oct 05;(10):CD001431
references.pmid: 21975733
references.citation: Am J Public Health. 2004 Aug;94(8):1336-8
references.pmid: 15284039
references.citation: Patient Educ Couns. 2011 Aug;84(2):e44-51
references.pmid: 21237611
references.citation: J Natl Cancer Inst. 2009 Sep 2;101(17):1216-20
references.pmid: 19671770
references.citation: Ann Fam Med. 2007 Mar-Apr;5(2):112-9
references.pmid: 17389534
references.citation: Ann Behav Med. 2012 Dec;44(3):320-30
references.pmid: 22825933
references.citation: Ann Fam Med. 2003 May-Jun;1(1):22-8
references.pmid: 15043176
references.citation: Med Decis Making. 1995 Apr-Jun;15(2):101-6
references.pmid: 7783569
references.citation: J Health Commun. 2010 Apr;15(3):307-21
references.pmid: 20432110
references.citation: Med Decis Making. 2001 Jan-Feb;21(1):37-44
references.pmid: 11206945
references.citation: BMC Med Inform Decis Mak. 2011 Nov 24;11:73
references.pmid: 22115059
references.citation: Patient Educ Couns. 2005 May;57(2):168-82
references.pmid: 15911190
references.citation: Patient Educ Couns. 2011 May;83(2):240-6
references.pmid: 20619576
references.citation: N Engl J Med. 2009 Mar 26;360(13):1310-9
references.pmid: 19297565
references.citation: Patient Educ Couns. 2006 Nov;63(3):367-79
references.pmid: 16875796
references.citation: Med Decis Making. 1996 Jan-Mar;16(1):58-64
references.pmid: 8717600
references.citation: J Gen Intern Med. 2008 Apr;23(4):466-71
references.pmid: 18373146
references.citation: J Health Commun. 2012;17(6):677-97
references.pmid: 21919646
references.citation: Ann Fam Med. 2012 Nov-Dec;10(6):491-4
references.pmid: 23149524
references.citation: J Med Screen. 2003;10(1):27-39
references.pmid: 12790313
references.citation: Cancer. 2002 Sep 1;95(5):1037-44
references.pmid: 12209688
references.citation: J Natl Cancer Inst. 2012 Jan 18;104(2):125-32
references.pmid: 22228146
references.citation: N Engl J Med. 2009 Mar 26;360(13):1320-8
references.pmid: 19297566
references.citation: J Gen Intern Med. 2003 Oct;18(10):781-7
references.pmid: 14521639
references.citation: Patient Educ Couns. 1999 Jul;37(3):255-63
references.pmid: 14528551
references.citation: Arch Intern Med. 2009 Sep 28;169(17):1611-8
references.pmid: 19786681
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2179-88
references.pmid: 17119044
references.citation: J Natl Med Assoc. 2005 Aug;97(8):1143-54
references.pmid: 16173330
references.citation: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references.pmid: 22237781
references.citation: BMJ. 2006 Aug 26;333(7565):417
references.pmid: 16908462
references.citation: Cancer. 2011 Aug 1;117(15):3352-62
references.pmid: 21319147
references.citation: Patient Educ Couns. 2013 Jun;91(3):329-36
references.pmid: 23357414
references.citation: N Engl J Med. 2012 Aug 16;367(7):595-605
references.pmid: 22894572
references.citation: JAMA. 2011 Jan 19;305(3):300-1
references.pmid: 21245186
references.citation: J Gen Intern Med. 2004 Aug;19(8):835-42
references.pmid: 15242468
references.citation: Health Educ Behav. 2006 Jun;33(3):352-73
references.pmid: 16699125
references.citation: Health Aff (Millwood). 2007 May-Jun;26(3):716-25
references.pmid: 17485749
references.citation: J Fam Pract. 2000 May;49(5):418-24
references.pmid: 10836772
references.citation: JAMA. 2012 Feb 8;307(6):565-6
references.pmid: 22318274
references.citation: Health Aff (Millwood). 2004;Suppl Variation:VAR63-72
references.pmid: 15471770
references.citation: N Engl J Med. 2012 Mar 15;366(11):981-90
references.pmid: 22417251
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Sep;19(9):2172-86
references.pmid: 20716619
references.citation: Patient Educ Couns. 2008 Dec;73(3):482-9
references.pmid: 18760888
references.citation: World J Urol. 2008 Aug;26(4):365-73
references.pmid: 18421460
references.citation: Patient Educ Couns. 2010 Feb;78(2):166-8
references.pmid: 19665338
references.citation: Eff Clin Pract. 2001 May-Jun;4(3):112-20
references.pmid: 11434074
references.citation: Med Care. 2003 May;41(5):582-92
references.pmid: 12719681
references.citation: Am J Prev Med. 2007 Nov;33(5):428-434
references.pmid: 17950409
references.citation: BMC Med Inform Decis Mak. 2010 Mar 03;10:12
references.pmid: 20199680
references.citation: Arch Intern Med. 2009 Sep 28;169(17):1554-6
references.pmid: 19786672
references.citation: ACP J Club. 2001 Jul-Aug;135(1):A11-2
references.pmid: 11471526
references.citation: Arch Intern Med. 2008 Feb 25;168(4):363-9
references.pmid: 18299490