Impact of a printed decision aid on patients' intention to undergo prostate cancer screening: a multicentre, pragmatic randomised controlled trial in primary care.
BACKGROUND
Despite recommendations against systematic screening for prostate cancer, 70% of patients still request prostate-specific antigen testing.


OBJECTIVE
To assess the impact of a decision aid on patients' intention to undergo prostate cancer screening.


METHODS
Randomised controlled trial with two-arm parallel groups in 86 general practices in urban and rural areas in France.


METHODS
Males aged 50-75 years were randomised to receive either the decision aid (intervention group) or usual care (control group). The primary outcome was the proportion of patients' intending to undergo prostate cancer screening, assessed immediately after reading the decision aid. The reasons underlying their choice were elicited and the proportion of patients citing each reason to undergo, or not undergo, prostate cancer screening were compared between the two arms.


RESULTS
A total of 1170 patients were randomised (588 in the intervention arm) from November 2012 to February 2013. The proportion of patients who intended to be tested for prostate cancer in the intervention arm (123 patients [20.9%]) was significantly reduced compared with the control arm (57 patients [9.8%]) (difference 11.1%, 95% confidence interval [CI] = 7.0 to 15.2, P<0.0001). In the intervention group, a lower proportion of individuals expressed that cancer screening would protect them from the disease, compared with the control group (P<0.0001), while a greater proportion of individuals stated that prostate cancer screening would not benefit their health (P<0.0001) and may involve procedures with harmful side effects (P = 0.0005).


CONCLUSIONS
The decision aid improved participants' informed decision making and reduced their intent to undergo prostate cancer screening.
Department of General Medicine, Paris Diderot University, Paris, France.
Viet-Thi
VT
Tran
Department of General Medicine, Paris Descartes University, Paris, France.
Elena
E
Kisseleva-Romanova
Department of General Medicine, Paris Descartes University, Paris, France.
Laurent
L
Rigal
Paris Descartes University, Paris, France, and Société de Formation Thérapeutique du Généraliste, Paris, France.
Hector
H
Falcoff
D000368:Aged; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010358:Patient Participation; D011320:Primary Health Care / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology
decision making; early detection of cancer; primary care; prostatic neoplasm; randomised controlled trial