title: Responses to a Decision Aid on Prostate Cancer Screening in Primary Care Practices.
abstract: BACKGROUND
  Prostate-specific antigen (PSA) testing remains controversial, with most guidelines recommending shared decision making. This study describes men's PSA screening preferences before and after viewing a decision aid and relates these preferences to subsequent clinician visit content.
  
  
  METHODS
  Men were recruited from two health systems in 2009-2013. Participants answered a questionnaire before and after decision aid viewing addressing PSA screening preferences and five basic knowledge questions. At one health system, participants also answered a survey after a subsequent clinician visit. Data were analyzed in 2014.
  
  
  RESULTS
  One thousand forty-one predominantly white, well-educated men responded to the pre- and post-viewing questionnaire (25% and 29% response rates at the two sites). After viewing, the proportion of patients leaning away from PSA screening increased significantly (p<0.001), with 386 (38%) leaning toward PSA screening versus 436 (43%) before viewing; 174 (17%) unsure versus 319 (32%) before; and 448 (44%) leaning away versus 253 (25%) before. Higher knowledge scores were associated with being more likely to lean against screening and less likely to be unsure (p<0.001). Among 278 men who also completed a questionnaire after a subsequent clinician visit, participants who planned to discuss PSA screening with their clinicians were significantly more likely to report such discussions than participants who did not (148/217 [68%] vs 16/46 [35%], respectively [p<0.001]).
  
  
  CONCLUSIONS
  A decision aid reduces men's interest in PSA screening, particularly among the initially unsure. Men who plan to discuss PSA screening with their clinician after a decision aid are more likely to do so.
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts. Electronic address: mbarry@imdfoundation.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barry
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Wexler
authors.affiliation: Dartmouth Institute, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Brackett
authors.affiliation: Decision Sciences Unit of the General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen R
authors.initials: KR
authors.lastname: Sepucha
authors.affiliation: Decision Sciences Unit of the General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Leigh H
authors.initials: LH
authors.lastname: Simmons
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts.
authors.forename: Bethany S
authors.initials: BS
authors.lastname: Gerstein
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts.
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Stringfellow
authors.affiliation: Informed Medical Decisions Foundation, Boston, Massachusetts.
authors.forename: Floyd J
authors.initials: FJ
authors.lastname: Fowler
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data; D011320:Primary Health Care; D011471:Prostatic Neoplasms / Q000175:diagnosis*