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Espinosa M, Butler SA, Mengelkoch S, Prieto LJ, Russell E, Ramshaw C, Rose-Reneau Z, Remondino M, Nahavandi S, Hill SE. The Impact of a Digital Contraceptive Decision Aid on User Outcomes: Results of an Experimental, Clinical Trial. Ann Behav Med 2024; 58:463-473. [PMID: 38828482 DOI: 10.1093/abm/kaae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. PURPOSE To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. METHODS In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. RESULTS Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. CONCLUSIONS Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. CLINICAL TRIALS REGISTRATION # NCT05177783, ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783.
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Affiliation(s)
- Matthew Espinosa
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | | | - Summer Mengelkoch
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | | | | | | | - Zak Rose-Reneau
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Molly Remondino
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | | | - Sarah E Hill
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
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2
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Lippey J, Keogh L, Campbell I, Mann GB, Forrest LE. Impact of a risk based breast screening decision aid on understanding, acceptance and decision making. NPJ Breast Cancer 2023; 9:65. [PMID: 37553371 PMCID: PMC10409718 DOI: 10.1038/s41523-023-00569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
Internationally, population breast cancer screening is moving towards a risk-stratified approach and requires engagement and acceptance from current and future screening clients. A decision aid ( www.defineau.org ) was developed based on women's views, values, and knowledge regarding risk-stratified breast cancer screening. This study aims to evaluate the impact of the decision aid on women's knowledge, risk perception, acceptance of risk assessment and change of screening frequency, and decision-making. Here we report the results of a pre and post-survey in which women who are clients of BreastScreen Victoria were invited to complete an online questionnaire before and after viewing the decision aid. 3200 potential participants were invited, 242 responded with 127 participants completing both surveys. After reviewing the decision aid there was a significant change in knowledge, acceptance of risk-stratified breast cancer screening and of decreased frequency screening for lower risk. High levels of acceptance of risk stratification, genetic testing and broad support for tailored screening persisted pre and post review. The DEFINE decision aid has a positive impact on acceptance of lower frequency screening, a major barrier to the success of a risk-stratified program and may contribute to facilitating change to the population breast screening program in Australia.
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Affiliation(s)
- Jocelyn Lippey
- Sir Peter MacCallum Department of Oncology, Melbourne, Australia
- University of Melbourne, Department of Surgery, Melbourne, Australia
- St. Vincent's Hospital, Department of Surgery, Fitzroy, Australia
| | - Louise Keogh
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Ian Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gregory Bruce Mann
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Breast Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Laura Elenor Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.
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3
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Eiriksdottir VK, Baldursdottir B, Fridriksson JO, Valdimarsdottir HB. How Much Information Do Icelandic Men Receive on Pros and Cons of Prostate-Specific Antigen Testing Prior to Undergoing Testing? Am J Mens Health 2022; 16:15579883221097805. [PMID: 35608380 PMCID: PMC9134434 DOI: 10.1177/15579883221097805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate-specific antigen (PSA) testing for asymptomatic men is neither
encouraged nor discouraged in most countries; however, shared decision-making is
emphasized prior to PSA testing. The objective of this study was to examine to
what extent Icelandic men receive information about the pros and cons of PSA
testing. Furthermore, to explore if patient–provider communication about pros
and cons of PSA testing has improved in the last decade during which time more
emphasis has been placed on shared decision-making. All Icelandic men diagnosed
with prostate cancer in the years 2015 to 2020 were invited to participate, and
a total of 471 out of 1002 men participated (response rate 47.0%). Participants’
age ranged from 51 to 95 years (M = 71.9, SD =
7.3). Only half of the men received information about the pros and cons of PSA
testing, a third did not receive any information prior to testing and,
alarmingly, 22.2% of the men did not even know that they were being tested. A
majority of the participants lacked knowledge about the testing with half of the
men reporting that they had no knowledge about pros and cons of PSA testing
prior to testing. The findings have major public health relevance as they
indicate that information provided prior to PSA testing continue to be deficient
and that there is a pressing need for interventions that educate men about the
benefits and limitations of PSA testing before men undergo medical procedures
that can seriously affect their quality of life.
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Affiliation(s)
| | - Birna Baldursdottir
- Department of Psychology, Reykjavik
University, Reykjavik, Iceland
- Birna Baldursdottir, Department of
Psychology, Reykjavik University, Menntavegur 1, 102 Reykjavik, Iceland.
| | | | - Heiddis B. Valdimarsdottir
- Department of Psychology, Reykjavik
University, Reykjavik, Iceland
- Department of Population Health Science
and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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4
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Tiedje D, Borowski M, Simbrich A, Schlößler K, Kruse K, Bothe C, Kuss K, Adarkwah CC, Maisel P, Jendyk R, Kurosinski MA, Gerß J, Tschuschke C, Becker R, Roobol MJ, Bangma CH, Hense HW, Donner-Banzhoff N, Semjonow A. Decision aid and cost compensation influence uptake of PSA-based early detection without affecting decisional conflict: a cluster randomised trial. Sci Rep 2021; 11:23503. [PMID: 34873188 PMCID: PMC8648904 DOI: 10.1038/s41598-021-02696-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
International guidelines recommend to inform men about the benefits and harms of prostate specific antigen (PSA) based early detection of prostate cancer. This study investigates the influence of a transactional decision aid (DA) or cost compensation (CC) for a PSA test on the decisional behaviour of men. Prospective, cluster-randomised trial to compare two interventions in a 2 × 2 factorial design: DA versus counselling as usual, and CC versus noCC for PSA-testing. 90 cluster-randomised physicians in the administrative district of Muenster, Germany recruited 962 participants aged 55-69 yrs. in 2018. Primary endpoint: the influence of the DA and CC on the decisional conflict. Secondary endpoints: factors which altered the involvement of the men regarding their decision to take a PSA-test. The primary endpoint was analysed by a multivariate regression model. The choice to take the PSA test was increased by CC and reduced by the DA, the latter also reduced PSA uptake in men who were offered CC. The DA led to an increase of the median knowledge about early detection, changed willingness to perform a PSA test without increasing the level of shared decision, giving participants a stronger feeling of having made the decision by themselves. The DA did not alter the decisional conflict, as it was very low in all study groups. DA reduced and CC increased the PSA uptake. The DA seemed to have a greater impact on the participants than CC, as it led to fewer PSA tests even if CC was granted.Trial registration: German Clinical Trial Register (Deutsches Register Klinischer Studien DRKS00007687). Registered: 06/05/2015. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007687 .
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Affiliation(s)
- Dorothee Tiedje
- Prostate Center, University Hospital Muenster, Muenster, Germany.
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Alexandra Simbrich
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Kathrin Schlößler
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany.,Department of General Practice/Family Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Kruse
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Christiane Bothe
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Katrin Kuss
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Peter Maisel
- Department of General Medicine, University Hospital Muenster, Muenster, Germany
| | - Ralf Jendyk
- Department of General Medicine, University Hospital Muenster, Muenster, Germany
| | - Marc-André Kurosinski
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Christian Tschuschke
- Berufsverband der Deutschen Urologen, Landesverband Westfalen-Lippe, Muenster, Germany
| | - Ralf Becker
- Hausaerzteverbund Muenster, Muenster, Germany
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany
| | - Axel Semjonow
- Prostate Center, University Hospital Muenster, Muenster, Germany
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5
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Bernal-Soriano MC, Parker LA, López-Garrigós M, Hernández-Aguado I, Gómez-Pérez L, Caballero-Romeu JP, Pastor-Valero M, García N, Alfayate-Guerra R, Lumbreras B. Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines? J Clin Med 2021; 10:jcm10122650. [PMID: 34208627 PMCID: PMC8234229 DOI: 10.3390/jcm10122650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 12/15/2022] Open
Abstract
Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62-69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02-1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67-0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.
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Affiliation(s)
- Mari Carmen Bernal-Soriano
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-9659-195-07
| | - Lucy Anne Parker
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Maite López-Garrigós
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Clinical Laboratory Department, University Hospital of San Juan de Alicante, Sant Joan d’Alacant, 03550 Alicante, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Luis Gómez-Pérez
- Urology Department, University Hospital of San Juan de Alicante, 03550 Alicante, Spain;
- Pathology and Surgery Department, Miguel Hernández University of Elche, 03550 Alicante, Spain
| | - Juan-Pablo Caballero-Romeu
- Department of Urology, University General Hospital of Alicante, 03010 Alicante, Spain; (J.-P.C.-R.); (N.G.)
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - María Pastor-Valero
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Nuria García
- Department of Urology, University General Hospital of Alicante, 03010 Alicante, Spain; (J.-P.C.-R.); (N.G.)
| | - Rocío Alfayate-Guerra
- Clinical Laboratory Department, University General Hospital of Alicante, 03010 Alicante, Spain;
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain; (L.A.P.); (I.H.-A.); (M.P.-V.); (B.L.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
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6
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Linden I, Wolfs C, Perry M, Metsemakers J, van der Weijden T, de Vugt M, Verhey FR, Handels R, Olde Rikkert M, Dirksen C, Ponds RWHM. Implementation of a diagnostic decision aid for people with memory complaints and their general practitioners: a protocol of a before and after pilot trial. BMJ Open 2021; 11:e049322. [PMID: 34135053 PMCID: PMC8211080 DOI: 10.1136/bmjopen-2021-049322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Researchers, policy-makers and healthcare professionals often stress the importance of an early dementia diagnosis. Empirical evidence, however, is scarce leading to a lack of consensus on the necessity of diagnosing dementia early. We emphasise the need for a 'timely' diagnosis, that is, one that occurs at the right moment for a person with memory complaints and his/her significant other. As the optimal timing differs between individuals, the implementation of shared decision making (SDM), preferably by the general practitioner (GP), as the start of a diagnostic trajectory, could help to determine this timely moment. SDM, however, is rarely practised with respect to dementia diagnoses. Therefore, in the context of the Shared Decision-Making regarding Dementia Diagnosis project, a patient decision aid (PtDA) for 'timely' dementia diagnosis in general practice will be developed. This protocol will describe the planned before and after evaluation of its implementation. METHODS AND ANALYSIS In a mixed-methods pilot study, we will investigate decision-making processes and experiences regarding a diagnostic trajectory before and after the introduction of a PtDA for people with memory complaints, their significant others and their GPs. The 'before group' will receive diagnostics as usual from their GPs. The 'after group' will use the PtDA. We expect the PtDA to increase the level of SDM and to contribute to a timely and personalised diagnostic trajectory. Data will be collected using semistructured interviews, questionnaires and information retrieved from people with memory complaints' medical records. ETHICS AND DISSEMINATION This study protocol was approved by the Medical Review Ethics Committee of the Maastricht University Medical Centre. The findings will be published in peer-reviewed international journals and presented at conferences. This study was funded by the public funded Dutch Research Institute for Care and Medical Sciences (ZonMw). TRIAL REGISTRATION NUMBER NCT04531956.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands
| | - Job Metsemakers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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7
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Pryce H, Ward M, Turton L, Stanley J, Goss J. A multi-site service evaluation of the tinnitus care decision aid. Int J Audiol 2021; 61:84-87. [PMID: 33752559 DOI: 10.1080/14992027.2021.1898684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Shared decision-making is a principle of health care delivery across the world. The first international standard decision aid for tinnitus care was developed in 2018. This decision aid is in use across the UK. It is free to use and access from the British Tinnitus Association website. Our objective was to compare routine care with the care that also included the decision aid as part of care for their patients. DESIGN A multi-site service evaluation included pre-post comparison of decisional conflict in sequential new patients seeking help with tinnitus. Informal interviews with staff and service managers explored how practical and feasible the decision aid was in routine practice. STUDY SAMPLE We present data from four contrasting clinical services, including services in England and Wales, acute and community services and those operated by Hearing Therapists and Audiologists. RESULTS Across these contrasting services, the inclusion of the decision aid was associated with a reduction in decisional conflict in patients. The decision aid was feasible to administer, acceptable to patients and clinicians without creating a burden in appointments. CONCLUSIONS These evaluations suggest that the decision aid is feasible to administer and reduces patient decisional conflict. It appears to benefit clinical services in practice.
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Affiliation(s)
- Helen Pryce
- Audiology Department, College of Health and Life Sciences, Aston University, Birmingham, UK.,Hearing Therapy and Audiology Service, St Martins Hospital, Bath, UK
| | - Melanie Ward
- Hearing Therapy and Audiology Service, St Martins Hospital, Bath, UK
| | - Laura Turton
- Audiology Department, South Warwickshire Foundation NHS Trust, Warwick Hospital, Warwick, UK
| | - Joanne Stanley
- Audiology Department, Worcestershire Acute NHS Trust, Alexandra Hospital, Redditch, UK
| | - Joanne Goss
- Audiology Department, Betsi Cadwaladr University Health Board, Wales, UK
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9
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Nguyen DD, Trinh QD, Cole AP, Kilbridge KL, Mahal BA, Hayn M, Hansen M, Han PKJ, Sammon JD. Impact of health literacy on shared decision making for prostate-specific antigen screening in the United States. Cancer 2020; 127:249-256. [PMID: 33165954 DOI: 10.1002/cncr.33239] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Current guidelines endorse shared decision making (SDM) for prostate-specific antigen (PSA) screening. The relationship between a patient's health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening. METHODS Using data from the 2016 Behavioral Risk Factor Surveillance System, the authors examined PSA screening in the 13 states that administered the optional "Health Literacy" module. Men aged ≥50 years were examined. Complex samples multivariable logistic regression models were computed to assess the odds of undergoing PSA screening. The interactions between HL and SDM were also examined. RESULTS A weighted sample of 12.249 million men with a rate of PSA screening of 33.4% were identified. Approximately one-third self-identified as having optimal HL. Rates of PSA screening were found to be highest amongst the highest HL group (42.2%). Being in this group was a significant predictor of undergoing PSA screening (odds ratio, 1.214; 95% confidence interval, 1.051-1.403). There was a significant interaction observed between HL and SDM (P for interaction, <.001) such that higher HL was associated with a lower likelihood of undergoing PSA screening when SDM was present. CONCLUSIONS In the uncertain environment of multiple contradictory screening guidelines, men who reported higher levels of HL were found to have higher levels of screening. The authors demonstrated that increased HL may reduce the screening-promoting effect of SDM. These findings highlight the dynamic interplay between HL and SDM that should inform the creation and promulgation of SDM guidelines, specifically when considering patients with low HL.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P Cole
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kerry L Kilbridge
- Lank Center for Genitourinary Malignancy, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Brandon A Mahal
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matt Hayn
- School of Medicine, Tufts University, Boston, Massachusetts.,Division of Urology, Maine Medical Center, Portland, Maine
| | - Moritz Hansen
- School of Medicine, Tufts University, Boston, Massachusetts.,Division of Urology, Maine Medical Center, Portland, Maine.,Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
| | - Paul K J Han
- School of Medicine, Tufts University, Boston, Massachusetts.,Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
| | - Jesse D Sammon
- School of Medicine, Tufts University, Boston, Massachusetts.,Division of Urology, Maine Medical Center, Portland, Maine.,Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
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10
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French WW, Wallen EM. Advances in the diagnostic options for prostate cancer. Postgrad Med 2020; 132:52-62. [PMID: 32900250 DOI: 10.1080/00325481.2020.1822067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Over the past decade, despite the controversies surrounding prostate cancer screening, significant refinements have improved its application. PSA screening, although it has been questioned, appears to confer a mortality benefit and remains the most effective way to identify the possible presence of prostate cancer. Methods to improve the specificity of PSA screening and limit overdiagnosis of indolent cancers, including risk-stratified screening regimens, are currently being utilized. Certain imaging modalities, such as multiparametric MRI, have proven to be excellent adjuncts providing improved risk stratification and the ability for targeted biopsies; however, concerns over variability in interpretation and generalizability persist. A number of novel biomarkers have become available with nearly all demonstrating the ability to improve upon the specificity of PSA screening; however, optimal timing, direct comparisons, and usefulness in conjunction with imaging modalities remain to be elucidated. With the improvement in testing options and recognition of the risk/benefit ratio for men undergoing screening for prostate cancer, the increasing role of shared decision making in the process is emphasized.
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Affiliation(s)
- William W French
- Department of Urology, University of North Carolina Medical Center , Chapel Hill, NC, United States
| | - Eric M Wallen
- Department of Urology, University of North Carolina Medical Center , Chapel Hill, NC, United States
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11
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Rho MJ, Park J, Moon HW, Lee C, Nam S, Kim D, Kim CS, Jeon SS, Kang M, Lee JY. Dr. Answer AI for prostate cancer: Clinical outcome prediction model and service. PLoS One 2020; 15:e0236553. [PMID: 32756597 PMCID: PMC7406030 DOI: 10.1371/journal.pone.0236553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/08/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives The importance of clinical outcome prediction models using artificial intelligence (AI) is being emphasized owing to the increasing necessity of developing a clinical decision support system (CDSS) employing AI. Therefore, in this study, we proposed a “Dr. Answer” AI software based on the clinical outcome prediction model for prostate cancer treated with radical prostatectomy. Methods The Dr. Answer AI was developed based on a clinical outcome prediction model, with a user-friendly interface. We used 7,128 clinical data of prostate cancer treated with radical prostatectomy from three hospitals. An outcome prediction model was developed to calculate the probability of occurrence of 1) tumor, node, and metastasis (TNM) staging, 2) extracapsular extension, 3) seminal vesicle invasion, and 4) lymph node metastasis. Random forest and k-nearest neighbors algorithms were used, and the proposed system was compared with previous algorithms. Results Random forest exhibited good performance for TNM staging (recall value: 76.98%), while k-nearest neighbors exhibited good performance for extracapsular extension, seminal vesicle invasion, and lymph node metastasis (80.24%, 98.67%, and 95.45%, respectively). The Dr. Answer AI software consisted of three primary service structures: 1) patient information, 2) clinical outcome prediction, and outcomes according to the National Comprehensive Cancer Network guideline. Conclusion The proposed clinical outcome prediction model could function as an effective CDSS, supporting the decisions of the physicians, while enabling the patients to understand their treatment outcomes. The Dr. Answer AI software for prostate cancer helps the doctors to explain the treatment outcomes to the patients, allowing the patients to be more confident about their treatment plans.
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Affiliation(s)
- Mi Jung Rho
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihwan Park
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sejin Nam
- LifeSemantics, Seoul, Republic of Korea
| | | | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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12
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Cooper DL, Rollins L, Slocumb T, Rivers BM. Are Men Making Informed Decisions According to the Prostate-Specific Antigen Test Guidelines? Analysis of the 2015 Behavioral Risk Factor Surveillance System. Am J Mens Health 2020; 13:1557988319834843. [PMID: 30836815 PMCID: PMC6440290 DOI: 10.1177/1557988319834843] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The prostate-specific antigen (PSA) screening recommendation endorses the opportunity for men to make an informed decision about whether or not to screen. This entails speaking with a provider to discuss the potential advantages, disadvantages, and uncertainties about the PSA screening test. The purpose of this study was to examine (a) the reported level of being informed about the PSA test by race and (b) the association between the receipt of the PSA test and participants reporting that they were informed about the test. U.S. adult males (ages 40–74 years) were identified from the 2015 Behavioral Risk Factors Surveillance System (BRFSS; n = 3,877). Chi-square analysis assessed bivariate differences among men who received different levels of PSA screening information. Binomial logistic regression models assessed the relationship of race/ethnicity and the receipt of the PSA test on being informed about the PSA test. Over half (54.3%) of the sample had a PSA test and most (72.0%) reported that they did not receive information about both the advantages and disadvantages (being informed) of the PSA test. Black men (40.3%) were significantly most likely to report being informed (p < .001), and 61.3% reported receipt of a recommendation from their provider (p < .001). White men (63.1%) were significantly more likely to report receiving the PSA test. Findings indicate that more men reported receiving the PSA test than men who reported being informed about it. Future research and interventions should strive for men of all racial and ethnic backgrounds to be informed about the PSA test before making a decision.
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Affiliation(s)
- Dexter L Cooper
- 1 Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Cancer Health Equity Institute, Atlanta, GA, USA
| | - Latrice Rollins
- 2 Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, Atlanta, GA, USA
| | - Tanesha Slocumb
- 2 Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Prevention Research Center, Atlanta, GA, USA
| | - Brian M Rivers
- 1 Morehouse School of Medicine, Department of Community Health and Prevention Medicine, Cancer Health Equity Institute, Atlanta, GA, USA
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13
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Fredsøe J, Koetsenruyter J, Vedsted P, Kirkegaard P, Væth M, Edwards A, Ørntoft TF, Sørensen KD, Bro F. The effect of assessing genetic risk of prostate cancer on the use of PSA tests in primary care: A cluster randomized controlled trial. PLoS Med 2020; 17:e1003033. [PMID: 32032355 PMCID: PMC7006905 DOI: 10.1371/journal.pmed.1003033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/15/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Assessing genetic lifetime risk for prostate cancer has been proposed as a means of risk stratification to identify those for whom prostate-specific antigen (PSA) testing is likely to be most valuable. This project aimed to test the effect of introducing a genetic test for lifetime risk of prostate cancer in general practice on future PSA testing. METHODS AND FINDINGS We performed a cluster randomized controlled trial with randomization at the level of general practices (73 in each of two arms) in the Central Region (Region Midtjylland) of Denmark. In intervention practices, men were offered a genetic test (based on genotyping of 33 risk-associated single nucleotide polymorphisms) in addition to the standard PSA test that informed them about lifetime genetic risk of prostate cancer and distinguished between "normal" and "high" risk. The primary outcome was the proportion of men having a repeated PSA test within 2 years. A multilevel logistic regression model was used to test the association. After applying the exclusion criteria, 3,558 men were recruited in intervention practices, with 1,235 (34.7%) receiving the genetic test, and 4,242 men were recruited in control practices. Men with high genetic risk had a higher propensity for repeated PSA testing within 2 years than men with normal genetic risk (odds ratio [OR] = 8.94, p < 0.01). The study was conducted in routine practice and had some selection bias, which is evidenced by the relatively large proportion of younger and higher income participants taking the genetic test. CONCLUSIONS Providing general practitioners (GPs) with access to a genetic test to assess lifetime risk of prostate cancer did not reduce the overall number of future PSA tests. However, among men who had a genetic test, knowledge of genetic risk significantly influenced future PSA testing. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, number NCT01739062.
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Affiliation(s)
- Jacob Fredsøe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Koetsenruyter
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (Cap), Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (Cap), Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- Department of Public Health, Randers Regional Hospital, Randers, Denmark
| | - Michael Væth
- Department of Public Health, Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Torben F. Ørntoft
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Karina D. Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (Cap), Aarhus University, Aarhus, Denmark
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14
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Riikonen JM, Guyatt GH, Kilpeläinen TP, Craigie S, Agarwal A, Agoritsas T, Couban R, Dahm P, Järvinen P, Montori V, Power N, Richard PO, Rutanen J, Santti H, Tailly T, Violette PD, Zhou Q, Tikkinen KAO. Decision Aids for Prostate Cancer Screening Choice: A Systematic Review and Meta-analysis. JAMA Intern Med 2019; 179:1072-1082. [PMID: 31233091 PMCID: PMC6593633 DOI: 10.1001/jamainternmed.2019.0763] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. OBJECTIVE To estimate the association of decision aids with decisional outcomes in prostate cancer screening. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. STUDY SELECTION Randomized trials comparing decision aids for prostate cancer screening with usual care. DATA EXTRACTION AND SYNTHESIS Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. MAIN OUTCOMES AND MEASURES Knowledge, decisional conflict, screening discussion, and screening choice. RESULTS Of 19 eligible trials (12 781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality). CONCLUSIONS AND RELEVANCE The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.
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Affiliation(s)
- Jarno M Riikonen
- Department of Urology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Science, University of Tampere, Tampere, Finland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tuomas P Kilpeläinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samantha Craigie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of General Internal Medicine, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis Veterans Administration Health Care System, Minneapolis, Minnesota.,Department of Urology, University of Minnesota, Minneapolis
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Patrick O Richard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jarno Rutanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Henrikki Santti
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thomas Tailly
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Philippe D Violette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, Woodstock General Hospital, Woodstock, Ontario, Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kari A O Tikkinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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15
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Scherer LD, Lin G. Decision Aids for Prostate Cancer Screening-The True Potential Remains Unknown. JAMA Intern Med 2019; 179:1082-1083. [PMID: 31233089 DOI: 10.1001/jamainternmed.2019.0753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Laura D Scherer
- Department of Medicine, Division of Cardiology, University of Colorado, Denver.,VA Denver Center of Innovation, Denver, Colorado
| | - Grace Lin
- Philip R. Lee Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco
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16
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Peña A, Qian Z, Lambrechts S, Cabri JN, Weiser C, Liu H, Kwan L, Saigal CS. Evaluation of Implementation Outcomes After Initiation of a Shared Decision-making Program for Men With Prostate Cancer. Urology 2019; 132:94-100. [PMID: 31299329 DOI: 10.1016/j.urology.2019.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/15/2019] [Accepted: 06/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate barriers to implementation of patient decision aids (PDAs) issued in an electronic medical record (EMR). We undertook an implementation outcomes analysis focused on what proportion of men eligible for the PDA received it (penetration), and of the men who received it, how many used it as intended (fidelity). We also evaluated various patient-centered outcomes related to decision-making. MATERIALS AND METHODS Men with incident localized prostate cancer were recruited from at UCLA from 2013 to 2017. PDA eligibility was determined via weekly EMR review. We also performed a retrospective chart review of all patients seen in clinic for one sample week to identify patients that were missed by the initial eligibility algorithm, and investigated the cause for miscategorization. We analyzed differences in patient-centered outcomes between those who did and did not receive the PDA. RESULTS About 314/374 men with incident prostate cancer completed the PDA conferring 84% fidelity. PDA penetration under initial identification prospective algorithm was assessed at 100% (n = 2/n = 2). However, penetration assessed by manual retrospective chart review was 20% (n = 2/n = 10). Improvements to the identification algorithm, including new EMR visit types, were identified. PDA completion was associated with less decisional conflict and higher perceived Shared decision-making (all P<.03). CONCLUSION No previous studies have investigated the challenges of implementing a PDA facilitated by the EMR. We identified modifiable system and EMR-related factors that limited program penetration. Our PDA showed decisional quality benefits.
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Affiliation(s)
- Adam Peña
- David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Zhiyu Qian
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sylvia Lambrechts
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - John N Cabri
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Casey Weiser
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Hui Liu
- Department of Pediatrics, University of Pittsburg, Pittsburgh, PA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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17
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Gokce Mİ, Akpınar C, Esen B, Solak V, Gülpınar O, Bedük Y. The role of a novel decision aid to support informed decision making process in patients with a symptomatic non - lower pole renal stone < 20 mm in diameter: a prospective randomized study. Int Braz J Urol 2019; 45:941-947. [PMID: 31268641 PMCID: PMC6844346 DOI: 10.1590/s1677-5538.ibju.2018.0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/28/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the efficacy of a novel decision aid (DA) in improving the patients’ level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone <2 cm. Materials and Methods In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. Results Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. Conclusions In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone <20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.
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Affiliation(s)
- Mehmet İlker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Cağrı Akpınar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Barış Esen
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Vahid Solak
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Omer Gülpınar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yaşar Bedük
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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18
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Owens OL, Kim S, Tavakoli AS. Are decision aids leading to shared prostate cancer screening decisions among African-American men?: iDecide. Cancer Causes Control 2019; 30:713-719. [PMID: 31093861 DOI: 10.1007/s10552-019-01179-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/09/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE African-Americans have prostate cancer mortality rates that are double their White counterparts. To reduce prostate cancer disparities, it is suggested that men engage in shared decision making about prostate cancer screening with their healthcare provider after learning about the benefits and harms of these screenings. While researchers have developed decision aids to support African-American's screening decisions, there is some uncertainty whether these aids lead to shared decision making. The goal of the current study was to investigate the efficacy of iDecide, a computerized decision aid, for promoting African-American men's engagement in shared decision making. METHODS Six months after their use of iDecide, a prostate cancer screening decision aid, 76 participants were surveyed to determine whether they spoke with a provider about screening, what this conversation entailed, and if shared decision making occurred. RESULTS While iDecide is an effective tool for enhancing African-American's intention to engage in shared decision making, there is no evidence this aid increased their likelihood of discussing prostate cancer with a provider or participation in shared decision making. CONCLUSION Future research should employ stronger research designs and assess the various contexts that can affect the relationship between decision-aid use and shared decision making among African-Americans.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, 1514 Pendleton Street, Columbia, SC, USA.
| | - Simon Kim
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Yale University Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Abbas S Tavakoli
- College of Nursing, University of South Carolina, Columbia, SC, USA
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19
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Jeihooni AK, Kashfi SM, Hatami M, Avand A, Bazrafshan MR. The Effect of Educational Program Based on PRECEDE Model in Promoting Prostate Cancer Screening in a Sample of Iranian Men. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:161-172. [PMID: 28913671 DOI: 10.1007/s13187-017-1282-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prostate cancer is one of the most prevalent diseases among men. This study aimed to assess the effect of educational program based on Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation (PRECEDE) model in promoting prostate cancer screening in a sample of Iranian men. This is a quasi-experimental study carried out on 300 men aged 40 to 70 (the subjects 150 experimental and 150 control groups) in Shiraz City, Fars Province, Iran, in 2016. The participants of the intervention group attended training based on the PRECEDE model. The study compared mean scores of knowledge, attitude, enabling factors, perceived social support, quality of life, general health, self-efficacy, and screening behaviors of the subjects before and 6 months after intervention in experimental and control groups. The mean age of experimental group was 56.45 ± 8.65, and the mean age of the control group was 55.64 ± 8.71 years (P = 0.521). The study showed that there was a significant increase in the mean score of knowledge, attitudes, perceived self-efficacy, enabling factors, perceived social support, quality of life, public health and screening behaviors of the experimental group; however, no significant change was observed in the mean score of knowledge, attitudes, self-efficacy, quality of life, general health, perceived social support, enabling factors, and screening behaviors of the control group. Our findings showed that the health education programs designed based on PRECEDE could positively affect prostate cancer screening behaviors of individuals by improving their knowledge level and attitude, enabling factors, perceived social support, quality of life, general health, and self-efficacy.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran.
| | - Seyyed Mansour Kashfi
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Hatami
- Department of Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Abulqasim Avand
- Department of Language, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad-Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
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20
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Pacyna JE, Radecki Breitkopf C, Jenkins SM, Sutton EJ, Horrow C, Kullo IJ, Sharp RR. Should pretest genetic counselling be required for patients pursuing genomic sequencing? Results from a survey of participants in a large genomic implementation study. J Med Genet 2018; 56:317-324. [PMID: 30580287 DOI: 10.1136/jmedgenet-2018-105577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE We assessed the decision-making of individuals pursuing genomic sequencing without a requirement for pretest genetic counselling. We sought to describe the extent to which individuals who decline genetic counselling reported decisional conflict or struggled to make a decision to pursue genomic testing. METHODS We administered a 100-item survey to 3037 individuals who consented to the Return of Actionable Variants Empirical study, a genomic medicine implementation study supported by the National Institutes of Health (USA) eMERGE consortium. The primary outcomes of interest were self-reported decisional conflict about the decision to participate in the study and time required to reach a decision. RESULTS We received 2895 completed surveys (response rate=95.3%), and of these respondents 97.8% completed the decisional conflict scale in its entirety. A majority of individuals (63%) had minimal or no decisional conflict about the pursuit of genomic sequencing and were able to reach a decision quickly (78%). Multivariable logistic regression analyses identified several characteristics associated with decisional conflict, including lower education, lower health literacy, lower self-efficacy in coping, lack of prior experience with genetic testing, not discussing study participation with a family member or friend, and being male. CONCLUSION As genomic sequencing is used more widely, genetic counselling resources may not be sufficient to meet demand. Our results challenge the notion that all individuals need genetic counselling in order to make an informed decision about genomic sequencing.
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Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sarah M Jenkins
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Horrow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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21
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Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis. Am J Prev Med 2018; 55:896-907. [PMID: 30337235 PMCID: PMC6467088 DOI: 10.1016/j.amepre.2018.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT Although screening recommendations for prostate cancer using prostate-specific antigen testing often include shared decision making, the effect of patient decision aids on patients' intention and uptake is unclear. This study aimed to review the effect of decision aids on men's screening intention, screening utilization, and the congruence between intentions and uptake. EVIDENCE ACQUISITION Data sources were searched through April 6, 2018, and included MEDLINE, Scopus, CENTRAL, CT.gov, Cochrane report, PsycARTICLES, PsycINFO, and reference lists. This study included RCTs and observational studies of decision aids that measured prostate screening intention or behavior. The analysis was completed in April 2018. EVIDENCE SYNTHESIS Eighteen studies (13 RCTs, four before-after studies, and one non-RCT) reported data on screening intention for ≅8,400 men and screening uptake for 2,385 men. Compared with usual care, the use of decision aids in any format results in fewer men (aged ≥40 years) planning to undergo prostate-specific antigen testing (risk ratio=0.88, 95% CI=0.81, 0.95, p=0.006, I2=66%, p<0.001, n=8). Many men did not follow their screening intentions during the first year after using a decision aid; however, most men who were planning to undergo screening did so (probability that men who wanted to be screened would receive screening was 95%). CONCLUSIONS Integration of decision aids in clinical practice may result in a decrease in the number of men who elect prostate-specific antigen testing, which may in turn reduce screening uptake. To ensure high congruence between intention and screening utilization, providers should not delay the shared decision-making discussion after patients use a decision aid.
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22
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Choi SK, Seel JS, Steck SE, Payne J, McCormick D, Schrock CS, Friedman DB. Talking About Your Prostate: Perspectives from Providers and Community Members. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1052-1060. [PMID: 28271389 PMCID: PMC5589476 DOI: 10.1007/s13187-017-1205-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Prostate cancer (PrCA) screening is controversial, especially for African-American (AA) men who have higher PrCA incidence and mortality than other racial/ethnic groups. Patient-provider communication is important for the PrCA screening decision process. The study purpose was to better understand the current dialogue between primary care providers (PCPs-physicians and nurse practitioners) and AA men about PrCA prevention and screening. An online survey with 46 PCPs, education sessions (including pre/post surveys) with 56 AA men, and a forum with 5 panelists and 38 AA men for open dialogue were held to examine both provider and community perspectives on PrCA communication needs and practices. PCPs' perceptions of PrCA screening were varied and they used different PrCA screening guidelines in their practices. PCPs and AA men had different experiences with PrCA communication. PCPs reported that they have discussions about PrCA screening and prostate health with AA patients; few AA men reported these same experiences. About 38.0% of PCPs reported that they remain neutral about PSA testing during discussions; however, only 10.7% of AA men reported that their doctor remained neutral. Prostate health knowledge among AA men increased significantly following participation in the education sessions (p < 0.001). AA community members reported high satisfaction regarding the education session and forum. Different recommendations from PCPs may hinder AA men's decisions about PrCA screening. The forum used in this study could be a model for others to help improve patient-provider communication and increase engagement in dialogue about this common cancer.
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Affiliation(s)
- Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Jessica S Seel
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Susan E Steck
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Johnny Payne
- UsTOO Greenville and Upstate Prostate Cancer Alliance, 412 Perry Hill Road, Easley, SC, 29640, USA
| | - Douglas McCormick
- Greenville Health System Cancer Institute, 900 W Faris Rd, Greenville, SC, 29605, USA
| | - Courtney S Schrock
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
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23
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Lowenstein LM, Escoto KH, Leal VB, Bailey L, Bevers TB, Cantor SB, Cinciripini PM, Jacobs LE, Esparza A, Godoy MC, Housten AJ, Lin H, Luckett P, Munden RF, Rabius V, Volk RJ. Randomized trial of a patient-centered decision aid for promoting informed decisions about lung cancer screening: Implementation of a PCORI study protocol and lessons learned. Contemp Clin Trials 2018; 72:26-34. [PMID: 30010085 PMCID: PMC6219628 DOI: 10.1016/j.cct.2018.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE We describe the methods, stakeholder engagement, and lessons learned from a study comparing a video decision aid to standard educational materials on lung cancer screening decisions. METHODS The study followed rigorous methodology standards from the Patient-Centered Outcomes Research Institute. The importance of patient-centeredness and patient/stakeholder engagement are reflected across the study's conceptualization, execution, interpretation, and dissemination efforts. Advisory groups of current and former smokers, quitline service providers, clinicians, and patient advocates were formed for the project. The study used both retrospective and prospective recruitment strategies. Randomization of patients occurred within state-based quitlines, with aggressive tracking of participants. We collected data at baseline and 1-week, 3-month and 6-months after receiving the intervention. The patient-centered outcomes included whether patients' receiving the decision aid a) felt better prepared to make a decision, b) felt more informed about the screening decision, c) had more clarity on their values regarding the benefits and harms of lung cancer screening, and d) were more knowledgeable about lung cancer screening than patients receiving the standard education materials. Exploratory outcomes included making an appointment with a health care provider to discuss screening, scheduling and completing lung cancer screening. RESULTS We have enrolled and randomized 516 quitline patients and learned many lessons about executing the trial based on significant patient and stakeholder engagement. CONCLUSIONS Conducting patient-centered outcomes research requires new ways of thinking and continuously checking-in with patients/stakeholders. The engagement of quitline service providers and patient advisors has been key to successful recruitment and dissemination planning. PCORI- CER-1306-03385 ClinicalTrials.gov NCT ID: NCT02286713.
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Affiliation(s)
- Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kamisha H Escoto
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Viola B Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Linda Bailey
- North American Quitline Consortium, Phoenix, AZ, United States
| | - Therese B Bevers
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lianne E Jacobs
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Myrna C Godoy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ashley J Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pamela Luckett
- Information & Quality Healthcare, Ridgeland, MS, United States
| | - Reginald F Munden
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Vance Rabius
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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24
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Misra-Hebert AD, Hom G, Klein EA, Bauman JM, Gupta N, Ji X, Stephenson AJ, Jones JS, Kattan MW. Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care. Front Oncol 2018; 8:238. [PMID: 30003062 PMCID: PMC6031706 DOI: 10.3389/fonc.2018.00238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed. Methods A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients’ knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar’s and Stuart–Maxwell tests were used to compare pre-and post-survey responses. Results 14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40–69 at the five clinics with 2–10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009). Conclusion A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients’ knowledge about the screening decision.
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Affiliation(s)
- Anita D Misra-Hebert
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States.,Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, United States.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Grant Hom
- Case Western Reserve University, Cleveland, OH, United States
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Janine M Bauman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Niyati Gupta
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, United States
| | - Xinge Ji
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Andrew J Stephenson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - J Stephen Jones
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
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25
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Lepore SJ, Nair RG, Davis SN, Wolf RL, Basch CE, Thomas N, Shmukler C, Ullman R. Patient and Physician Factors Associated with Undisclosed Prostate Cancer Screening in a Sample of Predominantly Immigrant Black Men. J Immigr Minor Health 2018; 19:1343-1350. [PMID: 27449217 DOI: 10.1007/s10903-016-0468-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medical guidelines do not recommend prostate cancer screening, particularly without informed and shared decision making. This study investigates undisclosed opportunistic screening using prostate specific antigen (PSA) testing in black immigrant and African American men. Participants (N = 142) were insured urban men, 45- to 70-years old. Patients' reports of testing were compared with medical claims to assess undisclosed PSA testing. Most (94.4 %) men preferred to share in screening decisions, but few (46.5 %) were aware PSA testing was performed. Four factors predicted being unaware of testing: low formal education, low knowledge about prostate cancer, no intention to screen, and no physician recommendation (all p's < .05). Undisclosed PSA testing was common. Both patient and provider factors increased risk of being uninformed about prostate cancer screening. Interventions combining patient education and physician engagement in shared decision making may better align practice with current prostate cancer screening guidelines.
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Affiliation(s)
- Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 957 Ritter Annex, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA.
| | - Rasmi G Nair
- Department of Biostatistics and Epidemiology, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA
| | - Stacy N Davis
- Department of Health Outcomes and Behaviors, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Randi L Wolf
- Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Charles E Basch
- Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Nigel Thomas
- 1199SEIU Benefit and Pension Funds, 330 W. 42nd Street, New York, NY, 10036, USA
| | - Celia Shmukler
- 1199SEIU Benefit and Pension Funds, 330 W. 42nd Street, New York, NY, 10036, USA
| | - Ralph Ullman
- 1199SEIU Benefit and Pension Funds, 330 W. 42nd Street, New York, NY, 10036, USA
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26
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Scherer LD, Kullgren JT, Caverly T, Scherer AM, Shaffer VA, Fagerlin A, Zikmund-Fisher BJ. Medical Maximizing-Minimizing Preferences Predict Responses to Information about Prostate-Specific Antigen Screening. Med Decis Making 2018; 38:708-718. [DOI: 10.1177/0272989x18782199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The recently developed Medical Maximizer-Minimizer Scale (MMS) assesses individual differences in preferences for active v. passive medical treatment. We hypothesized that men’s maximizing-minimizing preferences might have relevance in the case of prostate-specific antigen (PSA) screening, since there is considerable variability in men’s preference for being screened even among men who are informed that harm is more likely than benefit. The current research examined whether MMS preferences predict how men respond to didactic information and narrative stories about PSA screening. Design: US men 40+ years old ( N = 1208) participated in an online survey. Men viewed information about PSA screening in 3 phases and provided their preference for screening after each phase. Phase 1 described what PSA screening is. Phase 2 added didactic information about screening risks and benefits. Phase 3 added narrative stories; men were randomized to receive stories about 1) physical harm, 2) emotional harm, 3) overdiagnosis, or 4) all 3 stories. Participants also completed the validated MMS. Results: After receiving basic information, 76.8% of men wanted PSA screening. After receiving information about risks and benefits, 54.8% wanted screening (a significant reduction, P < 0.001). Men who changed their preferences were significantly more likely to be minimizers than maximizers; most men with maximizing tendencies wanted screening after both the didactic information and narratives, whereas most men with minimizing tendencies did not want the test after receiving information. Conclusions: Men who prefer a more minimizing approach to medicine are more responsive to evidence supporting limiting or forgoing screening than men who prefer a maximizing approach.
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Affiliation(s)
- Laura D. Scherer
- Department of Psychological Sciences, University of Missouri, Columbia MO, USA
| | - Jeffrey T. Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tanner Caverly
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Aaron M. Scherer
- Division of General Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Victoria A. Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia MO, USA
| | - Angela Fagerlin
- VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Brian J. Zikmund-Fisher
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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27
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Hararah MK, Stokes WA, Jones BL, Oweida A, Ding D, McDermott J, Goddard J, Karam SD. Nomogram for preoperative prediction of nodal extracapsular extension or positive surgical margins in oropharyngeal squamous cell carcinoma. Oral Oncol 2018; 83:73-80. [PMID: 30098782 DOI: 10.1016/j.oraloncology.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Extracapsular extension (ECE) in regional lymph nodes and positive surgical margins (PSM) are considered high-risk adverse pathologic features in patients with oropharyngeal squamous cell carcinoma (OPSCC) that each constitute an indication for postoperative adjuvant chemoradiation. We identify pre-operative clinical factors that can predict post-operative ECE and/or PSM and create a nomogram to help clinical decision making. METHODS Adult patients with non-metastatic OPSCC with initial surgical treatment and confirmed HPV status diagnosed between 2010 and 2014 were selected from the National Cancer Database. Clinical staging was modified to American Joint Committee on Cancer 8th edition parameters. Logistic regression was used for multivariate analysis to identify predictors of pathologic ECE and/or PSM. RESULTS 5065 patients were included. 47.5% of the 3336 HPV-positive (HPV+) patients had ECE/PSM. 40.4% of the 1729 HPV-negative (HPV-) patients with had ECE/PSM. A model was built that included age, clinical ECE, tumor grade, and clinical T and N staging for HPV+ patients. Increasing N-classification was highly predictive of pathologic ECE and/or PSM (N1 OR = 3.6, N2 OR = 7.0, N3 OR = 11.2, p < 0.01). Clinical ECE (OR = 4.1, p < 0.01), tumor grade (ORs 2.2-4.4 with p < 0.05), and increasing clinical T-classification (ORs 1.2-1.8, p < 0.05) were also associated with ECE and/or PSM. A similar model was built for HPV- with similar predictive capability. Two internally validated nomograms were designed that demonstrated good discrimination (HPV+ AUC = 0.66, 95% CI: 0.64-0.68, and HPV- AUC = 0.70, 95% CI: 0.67-0.72) and good calibration (goodness-of-fit statistic of HPV+ 6.32, p = 0.61 and HPV- 11.66, p = 0.17). CONCLUSIONS These are the first nomograms designed to help predict ECE or PSM for both HPV+ and HPV- OPSCC. The nomograms can facilitate shared decision-making between clinicians and patients as they consider upfront treatment selection for OPSCC.
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Affiliation(s)
- Mohammad K Hararah
- Departments of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, United States
| | - William A Stokes
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Bernard L Jones
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ayman Oweida
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ding Ding
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica McDermott
- Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Julie Goddard
- Departments of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sana D Karam
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
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Ilic D, Murphy K, Collins V, Holden C. Coaching to support men in making informed choices about prostate cancer screening: A qualitative study. PATIENT EDUCATION AND COUNSELING 2018; 101:872-877. [PMID: 29336860 DOI: 10.1016/j.pec.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening. METHODS Seven focus groups were conducted with 47 participants, representing three stakeholder groups - men, GPs and PNs. All focus group discussions were conducted by the same facilitator and guided by a semi-structured interview schedule. Transcriptions were analysed by thematic analysis. RESULTS Knowledge about the merits of prostate cancer screening was high amongst GPs, but limited with PNs and men. All groups saw the value in PN-led decision coaching for men considering screening for prostate cancer, but had reservations about its implementation in practice. Barriers to implementing a decision coaching system with PNs included staffing and cost of implementation. CONCLUSION GPs, PNs and men identified benefits for the use of a PN-led decision coaching support intervention to assist men with making an informed choice about screening for prostate cancer. Stakeholders had reservations about how a PN-led intervention would effectively work in clinical practice. PRACTICE IMPLICATIONS A feasibility study is required to examine barriers and enablers to implementing a PN-led decision coaching process for prostate cancer screening in the Australian primary healthcare setting.
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Affiliation(s)
- Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Veronica Collins
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Carol Holden
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia; Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Australia
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Gökce Mİ, Esen B, Sancı A, Akpınar C, Süer E, Gülpınar Ö. A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter. J Endourol 2018; 31:725-728. [PMID: 28467724 DOI: 10.1089/end.2017.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones <20 mm in diameter. MATERIALS AND METHODS The DA development process was established based on the recommended guides. General characteristics of the stone disease and details of the shockwave lithotripsy and retrograde intrarenal surgery were included in the content of the DA. The DA was further revised based on the suggestions of different physician groups and patients. The DA was evaluated by three physicians (Delphi assessment-International Patient Decision Aid Standards [IPDAS] Collaboration standards) and 25 patients (questionnaire of six questions with five-point Likert scale). RESULTS The DA was designed as a booklet, and Delphi group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. CONCLUSIONS This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.
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Affiliation(s)
- Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Barış Esen
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Adem Sancı
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Cağrı Akpınar
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Ömer Gülpınar
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
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Fedewa SA, Gansler T, Smith R, Sauer AG, Wender R, Brawley OW, Jemal A. Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States. Ann Fam Med 2018; 16. [PMID: 29531105 PMCID: PMC5847352 DOI: 10.1370/afm.2200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Previous studies report infrequent use of shared decision making for prostate-specific antigen (PSA) testing. It is unknown whether this pattern has changed recently considering increased emphasis on shared decision making in prostate cancer screening recommendations. Thus, the objective of this study is to examine recent changes in shared decision making. METHODS We conducted a retrospective cross-sectional study among men aged 50 years and older in the United States using 2010 and 2015 National Health Interview Survey (NHIS) data (n = 9,598). Changes in receipt of shared decision making were expressed as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Analyses were stratified on PSA testing (recent [in the past year] or no testing). Elements of shared decision making assessed included the patient being informed about the advantages only, advantages and disadvantages, and full shared decision making (advantages, disadvantages, and uncertainties). RESULTS Among men with recent PSA testing, 58.5% and 62.6% reported having received ≥1 element of shared decision making in 2010 and 2015, respectively (P = .054, aPR = 1.04; 95% CI, 0.98-1.11). Between 2010 and 2015, being told only about the advantages of PSA testing significantly declined (aPR = 0.82; 95% CI, 0.71-0.96) and full shared decision making prevalence significantly increased (aPR = 1.51; 95% CI, 1.28-1.79) in recently tested men. Among men without prior PSA testing, 10% reported ≥1 element of shared decision making, which did not change with time. CONCLUSION Between 2010 and 2015, there was no increase in shared decision making among men with recent PSA testing though there was a shift away from only being told about the advantages of PSA testing towards full shared decision making. Many men receiving PSA testing did not receive shared decision making.
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Affiliation(s)
- Stacey A Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, Georiga
| | - Ted Gansler
- Intramural Research Department, American Cancer Society, Atlanta, Georiga
| | - Robert Smith
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Intramural Research Department, American Cancer Society, Atlanta, Georiga
| | - Richard Wender
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Otis W Brawley
- Office of the Chief Medical Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, Atlanta, Georiga
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Holt CL, Le D, Slade JL, Muwwakkil B, Saunders DR, Williams R, Atkinson NL, Naslund M. Can Women Facilitate Men's Prostate Cancer Screening Informed Decision-Making? The M-PACT Trial. JOURNAL OF HEALTH COMMUNICATION 2017; 22:964-973. [PMID: 29173037 DOI: 10.1080/10810730.2017.1382616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The M-PACT study compared an all-male with a mixed-sex intervention to increase informed decision-making for prostate cancer screening among African-American men in church settings. We recruited 262 men in 18 churches randomized to the two intervention approaches. Trained and certified lay peer community health advisors in each church led a series of four men's health workshops on informed decision-making for prostate cancer screening. African-American male workshop participants completed baseline, post-workshop, and 12-month follow-up surveys. Contrary to our expectations, including women in the workshops did not result in increased intervention efficacy for the informed decision-making outcomes as both groups showed significant improvement over time in several study outcomes including stage of decision-making for prostate cancer screening, preference for role in decision-making, prostate cancer knowledge, and self-reports of prostate specific antigen testing. Finally, men who attended multiple workshops had better informed decision-making outcomes on several indicators. The current findings suggest mixed results from including women in this men's health educational intervention. Future work should consider optimal ways of providing family support for African-American men's health promotion.
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Affiliation(s)
- Cheryl L Holt
- a Department of Behavioral and Community Health, School of Public Health , University of Maryland , College Park , Maryland , USA
| | - Daisy Le
- a Department of Behavioral and Community Health, School of Public Health , University of Maryland , College Park , Maryland , USA
| | - Jimmie L Slade
- b Community Ministry of Prince George's County , Upper Marlboro , Maryland , USA
| | - Bettye Muwwakkil
- c Access to Wholistic & Productive Living, Inc ., Lanham , Maryland , USA
| | - Darlene R Saunders
- a Department of Behavioral and Community Health, School of Public Health , University of Maryland , College Park , Maryland , USA
| | - Ralph Williams
- c Access to Wholistic & Productive Living, Inc ., Lanham , Maryland , USA
| | | | - Michael Naslund
- e Department of Urology, University of Maryland Medical Center , Baltimore , Maryland , USA
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Ho A, Jameson K, Eiser A. Sowing the SEED for Patient Empowerment. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:42-45. [PMID: 29111939 DOI: 10.1080/15265161.2017.1378762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Anita Ho
- a University of British Columbia, University of California San Francisco, and Providence Health Care
| | - Kim Jameson
- b University of British Columbia and Vancouver Coastal Health Authority
| | - Arnold Eiser
- c University of Pennsylvania and Drexel University College of Medicine
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Patients' perceptions and attitudes on recurrent prostate cancer and hormone therapy: Qualitative comparison between decision-aid and control groups. J Geriatr Oncol 2017; 8:368-373. [DOI: 10.1016/j.jgo.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/28/2017] [Accepted: 05/26/2017] [Indexed: 11/24/2022]
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Scalia P, Elwyn G, Durand MA. "Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'. BMC Med Inform Decis Mak 2017; 17:124. [PMID: 28821256 PMCID: PMC5562992 DOI: 10.1186/s12911-017-0517-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022] Open
Abstract
Background Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Method Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. Results ‘Coherent’ motivations were guided by financial incentives at CapitalCare, and by a ‘champion’ physician at HealthPartners. Nurses worked ‘collectively’ at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Conclusion Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0517-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
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Laviana AA, Pannell SC, Huen KHY, Bergman J. Engaging patients in complex clinical decision-making: Successes, pitfalls, and future directions. Urol Oncol 2017; 35:569-573. [PMID: 28789928 DOI: 10.1016/j.urolonc.2017.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND By 2022, there will be 18 million predicted cancer survivors, which is an estimated 30% more than the number of survivors in 2012. In prostate cancer alone, the most common cancer in American men other than skin cancer, 1 in 7 men will be diagnosed during their lifetime. Nevertheless, only approximately 1 in 39 will actually die of the disease. Although life expectancy is often good, these men have multiple treatment management options to choose from, including active surveillance, surgery, or radiotherapy, each of which carries its own array of long-term adverse effects. The same applies to renal cancer where patient have to sift through information to decide among active surveillance, partial nephrectomy, racial nephrectomy, robotic vs. open surgery, and ablation. BASIC PROCEDURES Ultimately, patient, providers, and stakeholders lack high-quality evidence to effectively guide treatment decisions, and these decisions become even harder to discern when considering end-of-life care, palliative care, and the ethics regarding the new End of Life Option Act. As of November 1, 2016, the number of open urologic cancer clinical trials listed on ClinicalTrials.gov was 843. MAIN FINDINGS Although we continue to make tremendous strides in urologic cancer care, our options for choosing the best treatment from a patient and provider standpoint are seemingly growing murkier. We need to continue to understand how health-related quality of life varies from patient to patient, and ultimately, incorporate patient preferences and values into the treatment decision in order to make high-quality treatment decisions. CONCLUSIONS The remained of this articles will focus on the significant strides made in urologic oncology regarding these difficult decisions from localized disease to end-of-life care and also will detail what needs to be done as we continue to pivot forward.
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Affiliation(s)
- Aaron A Laviana
- Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA.
| | - Stephanie C Pannell
- Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Kathy H Y Huen
- Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Jonathan Bergman
- Department of Family Medicine, David Geffern School of Medicine at UCLA, Los Angeles, CA; Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA; Department of Urology, Olive View-UCLA Medical Center, Sylmar, CA
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Haider MR, Qureshi ZP, Horner R, Friedman DB, Bennett C. What Have Patients Been Hearing From Providers Since the 2012 USPSTF Recommendation Against Routine Prostate Cancer Screening? Clin Genitourin Cancer 2017. [PMID: 28625690 DOI: 10.1016/j.clgc.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this study we aimed to determine the relationship between prostate-specific antigen (PSA)-related information obtained from the provider and PSA test uptake. With recent focus on patient-provider communication (PC) and the guidelines recommending against PSA tests for prostate cancer (PCa), PC regarding the PSA test might affect PSA screening rates. MATERIALS AND METHODS We used the fourth edition of the Health Information National Trends Survey, a nationally-representative US survey on the use of cancer-related information. The survey was conducted in 3 cycles: October 2011 to January 2012 (cycle 1); October 2012 to January 2013 (cycle 2); September 2013 to October 2013 (cycle 3). Logistic regression was used to study the effect of PC on respondents' uptake of the PSA test. RESULTS Most of the respondents were 51 to 65 years old, white, with college or higher education, were married, and had health insurance. PC regarding the PSA test greatly increased the chances of screening for PCa using the PSA test in all 3 cycles (odds ratio [OR], 2.51 [95% confidence interval (CI), 2.03-3.10] in cycle 1; OR, 3.50 [95% CI, 2.51-4.88] in cycle 2; OR, 2.69 [95% CI, 2.02-3.58] in cycle 3). CONCLUSION Our study showed that PC increased the likelihood of patients undergoing PSA screening. In light of the 2012 US Preventive Services Task Force guidelines recommending against screening for PCa, PC seemed to have an opposite effect. Although updated PC that educates patients on the risks and benefits of PSA screening is needed, patients classically overemphasize benefits and underemphasize risks-which might increase rather than decrease PSA screening rates.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC; Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Zaina P Qureshi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC; Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC; William Jennings Bryan Dorn VA Medical Center, Columbia, SC.
| | - Ronnie Horner
- Department of Health Services Policy and Management, and Institute for the Advancement of Healthcare, University of South Carolina, Columbia, SC
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Charles Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, and Medication Safety, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC
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Rice LJ, Jefferson M, Briggs V, Delmoor E, Johnson JC, Gattoni-Celli S, Savage SJ, Lilly M, Prasad SM, Kittles R, Halbert CH. Discordance in perceived risk and epidemiological outcomes of prostate cancer among African American men. Prev Med Rep 2017; 7:1-6. [PMID: 28507891 PMCID: PMC5423348 DOI: 10.1016/j.pmedr.2017.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 11/16/2022] Open
Abstract
As guidelines for prostate cancer screening have changed from an annual screening recommendation starting at age 50 to discussing the benefits and harms of screening with health care providers, it is necessary to examine other types of factors that are important to prostate cancer screening decisions among African American men. Perceived risk of developing cancer has been shown to predict cancer control behaviors and is lower among African Americans. We characterized perceived risk of developing prostate cancer among African American men from November 2009 to 2011 and evaluated the relationship between prostate cancer risk perceptions and sociodemographic characteristics, health care experiences, and knowledge and exposure to health information about cancer. Chi square tests and logistic regression were employed to determine independent associations. Overall, men did not believe they were at increased risk of developing prostate cancer; they believed their risk was equivalent to or lower than men the same age. Perceived risk of prostate cancer was associated with income (OR = 0.59, 95% CI = 0.26, 1.34, p = 0.03), hypertension (OR = 2.68, 95% CI = 1.17, 6.16, p = 0.02), and beliefs about the association between race and cancer risk (OR = 2.54, 95% CI = 1.24, 5.20, p = 0.01). Clinic and community-based approaches to improve prostate cancer risk comprehension among African American men are needed to reduce the discordance between perceived risk and epidemiological data on prostate cancer risk factors. Risk education interventions that are developed for African American men may need to integrate information about susceptibility for multiple diseases as well as address strategies for risk reduction and prevention, and chronic disease management. Perceived risk was associated with income, hypertension and race and cancer risk. There is discordance in perceived risk for prostate cancer and risk outcomes data. Clinic and community-based approaches are needed to improve risk comprehension.
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Affiliation(s)
- LaShanta J Rice
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, United States
| | - Vanessa Briggs
- Health Promotion Services, Public Health Management Corporation, Pennsylvania, 260 South Broad Street, Philadelphia, PA 19102, United States
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, 1415 N. Broad Street, Suite 221B, Philadelphia, PA 19122, United States
| | - Jerry C Johnson
- Department of Medicine, Division of Geriatrics, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104-2676, United States
| | - Sebastiano Gattoni-Celli
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Charleston, SC, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Michael Lilly
- Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Sandip M Prasad
- Department of Urology, Medical University of South Carolina, Charleston, SC, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Rick Kittles
- Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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Engelen A, Vanderhaegen J, Van Poppel H, Van Audenhove C. The use of decision aids on early detection of prostate cancer: views of men and general practitioners. Health Expect 2017; 20:221-231. [PMID: 26890150 PMCID: PMC5354056 DOI: 10.1111/hex.12451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVE While decision support tools such as decision aids can contribute to shared decision making, implementing these tools in daily practice is challenging. To identify and address issues around the use of decision support tools in routine care, this study explores the views of men and general practitioners on using a DA for early detection of prostate cancer. METHODS, SETTING AND PARTICIPANTS Group discussions and semi-structured interviews were carried out with 43 men and 16 general practitioners familiar with a previously developed decision aid. Data were analysed using qualitative description. RESULTS Views on using the decision support tool could be classified into four categories: no need for decision making, need for support, perceived benefit and practical barriers. For each category, several underlying themes could be identified that reflect the absence or presence of prerequisites to successful decision support delivery. DISCUSSION AND CONCLUSION While men and general practitioners generally have positive attitudes to shared decision making, for both parties attitudes such as not agreeing that there is a decision to be made and doubts on the beneficence of using DAs were identified as factors that may hinder the use of a DA in clinical practice. Participants formulated strategies to support the use of DAs, mainly supplementing DAs with short tools and investing in both training programmes and large-scale awareness raising of the general public.
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Prostate cancer screening decision-making in three states: 2013 behavioral risk factor surveillance system analysis. Cancer Causes Control 2017; 28:235-240. [PMID: 28210882 DOI: 10.1007/s10552-017-0860-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Given the discordant prostate cancer screening recommendations in the United States, shared decision-making (SDM) has become increasingly important. The objectives of this study were to determine who made the final decision to obtain prostate-specific antigen (PSA)-based screening and identify factors associated with the screening decision made by both patients and their health care providers. METHODS Using the 2013 Behavioral Risk Factor Surveillance System data from Delaware, Hawaii, and Massachusetts, we calculated weighted percentages of SDM. Associations between the SDM and sociodemographic, lifestyle, access to care, and PSA testing-related factors were assessed using multivariate logistic regression. RESULTS There were 2,248 men aged 40 years or older who ever had a PSA-based screening in these three states. Only 36% of them made their prostate cancer screening decision jointly with their health care provider. Multivariate analyses showed that men who were married/living together or had a college degree and above were more likely to report having SDM than men who were never married or had less than high school education (P = 0.02 and 0.002). Moreover, men whose most recent PSA test occurred within the past year were more likely to report SDM than men who had the test done more than 2 years ago (P = 0.02). CONCLUSIONS The majority of screening decisions were made by the patient or health care provider alone in these three states, not jointly, as recommended. Our study points to the need to promote SDM among patients and their health care providers before PSA testing.
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Leyva B, Persoskie A, Ottenbacher A, Hamilton JG, Allen JD, Kobrin SC, Taplin SH. Do Men Receive Information Required for Shared Decision Making About PSA Testing? Results from a National Survey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:693-701. [PMID: 26498649 PMCID: PMC5515087 DOI: 10.1007/s13187-015-0870-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Most professional organizations, including the American College of Physicians and U.S. Preventive Services Task Force, emphasize that screening for prostate cancer with the prostate-specific antigen (PSA) test should only occur after a detailed discussion between the health-care provider and patient about the known risks and potential benefits of the test. In fact, guidelines strongly advise health-care providers to involve patients, particularly those at elevated risk of prostate cancer, in a "shared decision making" (SDM) process about PSA testing. We analyzed data from the National Cancer Institute's Health Information National Trends Survey 2011-2012-a nationally representative, cross-sectional survey-to examine the extent to which health professionals provided men with information critical to SDM prior to PSA testing, including (1) that patients had a choice about whether or not to undergo PSA testing, (2) that not all doctors recommend PSA testing, and (3) that no one is sure if PSA testing saves lives. Over half (55 %) of men between the ages of 50 and 74 reported ever having had a PSA test. However, only 10 % of men, regardless of screening status, reported receiving all three pieces of information: 55 % reported being informed that they could choose whether or not to undergo testing, 22 % reported being informed that some doctors recommend PSA testing and others do not, and 14 % reported being informed that no one is sure if PSA testing actually saves lives. Black men and men with lower levels of education were less likely to be provided this information. There is a need to improve patient-provider communication about the uncertainties associated with the PSA test. Interventions directed at patients, providers, and practice settings should be considered.
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Affiliation(s)
- Bryan Leyva
- Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA.
| | - Alexander Persoskie
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Allison Ottenbacher
- Science of Research and Technology Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer D Allen
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | - Sarah C Kobrin
- Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA
| | - Stephen H Taplin
- Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA
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Gökce MI, Wang X, Frost J, Roberson P, Volk RJ, Brooks D, Canfield SE, Pettaway CA. Informed decision making before prostate-specific antigen screening: Initial results using the American Cancer Society (ACS) Decision Aid (DA) among medically underserved men. Cancer 2016; 123:583-591. [PMID: 27727462 DOI: 10.1002/cncr.30367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The American Cancer Society (ACS) recommends men have the opportunity to make an informed decision about screening for prostate cancer (PCa). The ACS developed a unique decision aid (ACS-DA) for this purpose. However, to date, studies evaluating the efficacy of the ACS-DA are lacking. The authors evaluated the ACS-DA among a cohort of medically underserved men (MUM). METHODS A multiethnic cohort of MUM (n = 285) was prospectively included between June 2010 and December 2014. The ACS-DA was presented in a group format. Levels of knowledge on PCa were evaluated before and after the presentation. Participants' decisional conflict and thoughts about the presentation also were evaluated. Logistic regression analyses were performed to determine factors associated with having an adequate level of knowledge. RESULTS Before receiving the ACS-DA, 33.1% of participants had adequate knowledge on PCa, and this increased to 77% after the DA (P < .0001). On multivariate analysis, higher education level (odds ratio, 11.19; P = .001) and history of another cancer (odds ratio, 7.45; P = .03) were associated with having adequate knowledge after receiving the DA. Levels of decisional conflict were low and were correlated with levels of knowledge after receiving the DA. The majority of men also rated the presentation as favorable and would recommend the ACS-DA to others. CONCLUSIONS Use of the ACS-DA was feasible among MUM and led to increased PCa knowledge. This also correlated with low levels of decisional conflict. The ACS-DA presented to groups of men may serve as a feasible tool for informed decision making in a MUM population. Cancer 2017;123:583-591. © 2016 American Cancer Society.
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Affiliation(s)
- Mehmet I Gökce
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jacqueline Frost
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela Roberson
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Durado Brooks
- Cancer Control Interventions, American Cancer Society, Atlanta, Georgia
| | - Steven E Canfield
- Division of Urology, University of Texas Medical School at Houston, Houston, Texas
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Frencher SK, Sharma AK, Teklehaimanot S, Wadzani D, Ike IE, Hart A, Norris K. PEP Talk: Prostate Education Program, "Cutting Through the Uncertainty of Prostate Cancer for Black Men Using Decision Support Instruments in Barbershops". JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:506-513. [PMID: 26123763 DOI: 10.1007/s13187-015-0871-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to investigate the effectiveness of using decision support instruments (DSI) to assist African-American (AA) men in making a prostate cancer (CaP) screening decision. This nonrandomized pretest-posttest comparison study assessed two DSI that were either culturally tailored or culturally nonspecific. CaP knowledge, intention to screen, and preferences were assessed before and after exposure to DSI using a convenience sample of 120 AA men aged 40 years and above. Participants interested in screening were referred to healthcare providers through a community-based patient navigator to obtain prostate-specific antigen (PSA) testing. We followed up 3 months after to determine if participants screened for CaP. CaP knowledge increased following exposure to both DSI in equivalent proportions. While similar proportions of men ultimately intended on having a PSA test following both DSI, bivariate analysis revealed that the culturally tailored DSI demonstrated a statistically significant increase in intention to screen. Participants' degree of certainty in their decision-making process with regard to CaP screening increased following the culturally tailored DSI (p < .001). The majority of participants planned on discussing CaP screening with a healthcare provider upon completion of the study. Barbershop-based health education can change the knowledge, preferences, intentions, and behaviors of this at-risk population. At 3 months follow-up, half (n = 58) of the participants underwent PSA testing, which led to the diagnosis of CaP in one participant. Community-led interventions for CaP, such as cluster-randomized designs in barbershops, are needed to better assess the efficacy of DSI in community settings.
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Affiliation(s)
- Stanley K Frencher
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 650 Charles E Young Dr. South, 66-115 CHS, Los Angeles, CA, 90095, USA.
| | - Arun K Sharma
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 650 Charles E Young Dr. South, 66-115 CHS, Los Angeles, CA, 90095, USA
| | - Senait Teklehaimanot
- Department of Research - Life Sciences Institute, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - Dennis Wadzani
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - Ijeoma E Ike
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - Alton Hart
- Crater Health District, Virginia Department of Health, Richmond, 1501 West City Point Road, Hopewell, VA, 23860, USA
| | - Keith Norris
- David Geffen School of Medicine, University of California, Los Angeles, 650 Charles E Young Dr. South, 66-115 CHS, Los Angeles, CA, 90095, USA
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Degeling C, Carter SM, Rychetnik L. All care, but whose responsibility? Community juries reason about expert and patient responsibilities in prostate-specific antigen screening for prostate cancer. Health (London) 2016; 20:465-84. [PMID: 27491944 DOI: 10.1177/1363459316660862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
General practitioners have implicitly been given responsibility for guiding men's decisions about prostate-specific antigen-based screening for prostate cancer, but patients' expectations of the bounds of this responsibility remain unclear. We sought to explore how well-informed members of the public allocate responsibilities in prostate-specific antigen screening decision-making. In 2014, we convened two Community juries in Sydney, Australia, to address questions related to the content and timing of information provision and respective roles of patients and general practitioners in screening decisions. Participants in the first jury were of mixed gender and of all ages (n = 15); the participants in the second jury were all male and of screening age (n = 12). Both juries were presented with balanced factual evidence on the harms and benefits of prostate-specific antigen screening and expert perspectives on ethico-legal aspects of consent in medical practice. In their deliberations, jurors agreed that general practitioners should take responsibility for informing men of the options, risks and benefits of prostate-specific antigen testing, but arrived at different positions on whether or not general practitioners should also guide screening decisions. Jurors also disagreed on how much and when general practitioners should provide detailed information about biopsies and treatments. These responses suggest that for prostate-specific antigen testing, there is a public expectation that both the allocation of responsibility between general practitioners and their male patients, and the level of information provided will be tailored to individual men. In the presence of expert uncertainty, a well-informed public may have reason to embrace or resist shared decision-making processes.
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Affiliation(s)
- Chris Degeling
- The University of Sydney, AustraliaThe University of Notre Dame Australia, Australia
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Enard KR, Dolan Mullen P, Kamath GR, Dixon NM, Volk RJ. Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials. BMC Med Inform Decis Mak 2016; 16:64. [PMID: 27267490 PMCID: PMC4896023 DOI: 10.1186/s12911-016-0303-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/10/2016] [Accepted: 06/01/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is considered a key component of high quality cancer care and may be supported by patient decision aids (PtDAs). Many patients, however, face multiple social disadvantages that may influence their ability to fully participate in SDM or to use PtDAs; additionally, these social disadvantages are among the determinants of health associated with greater cancer risk, unwarranted variations in care and worse outcomes. The purpose of this systematic review is to describe the extent to which disadvantaged social groups in the United States (US) have been included in trials of cancer-related PtDAs and to highlight strategies, lessons learned and future opportunities for developing and evaluating PtDAs that are appropriate for disadvantaged populations. METHODS We selected cancer-related US studies from the Cochrane 2014 review of PtDAs and added RCTs meeting Cochrane criteria from searches of PubMed, CINAHL, PsycINFO (January 2010 to December 2013); and reference lists. Two reviewers independently screened titles/abstracts; three reviewers independently screened full text articles, performed data extraction and assessed: 1) inclusion of participants based on seven indicators of social disadvantage (limited education; female gender; uninsured or Medicaid status; non-U.S. nativity; non-White race or Hispanic ethnicity; limited English proficiency; low-literacy), and 2) attention to social disadvantage in the development or evaluation of PtDAs. RESULTS Twenty-three of 39 eligible RCTs included participants from at least one disadvantaged subgroup, most frequently racial/ethnic minorities or individuals with limited education and/or low-literacy. Seventeen studies discussed strategies and lessons learned in attending to the needs of disadvantaged social groups in PtDA development; 14 studies targeted disadvantaged groups or addressed subgroup differences in PtDA evaluation. CONCLUSIONS The diversity of the US population is represented in a majority of cancer-related PtDA RCTs, but fewer studies have tailored PtDAs to address the multiple social disadvantages that may impact patients' participation in SDM. More detailed attention to the comprehensive range of social factors that determine cancer risk, variations in care and outcomes is needed in the development and evaluation of PtDAs for disadvantaged populations. TRIAL REGISTRATION Registered 24 October 2014 in PROSPERO International prospective register of systematic reviews ( CRD42014014470 ).
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Affiliation(s)
- Kimberly R Enard
- Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, USA.
| | - Patricia Dolan Mullen
- Department of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, 7000 Fannin Street, UCT Suite 2522, Houston, TX, 77030, USA
| | - Geetanjali R Kamath
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1444, Houston, TX, USA
| | - Nickell M Dixon
- Michigan Department of Health and Human Services, 201 Townsend Street, Lansing, MI 48913, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1444, Houston, TX, USA
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Owens OL, Friedman DB, Brandt HM, Bernhardt JM, Hébert JR. Digital Solutions for Informed Decision Making: An Academic-Community Partnership for the Development of a Prostate Cancer Decision Aid for African American Men. Am J Mens Health 2016; 10:207-19. [PMID: 25563381 PMCID: PMC4492917 DOI: 10.1177/1557988314564178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
African American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups, and there is a critical need to identify strategies for providing information about PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM intervention for PrCA screening would be appropriate for AA men, this formative evaluation study examined their (1) PrCA risk and screening knowledge; (2) decision-making processes for PrCA screening; (3) usage of, attitudes toward, and access to interactive communication technologies (ICTs); and (4) perceptions regarding a future, novel, computer-based PrCA education intervention. A purposive convenience sample of 39 AA men aged 37 to 66 years in the Southeastern United States was recruited through faith-based organizations to participate in one of six 90-minute focus groups and complete a 45-item descriptive survey. Participants were generally knowledgeable about PrCA. However, few engaged in IDM with their doctor and few were informed about the associated risks and uncertainties of PrCA screening. Most participants used ICTs on a daily basis for various purposes including health information seeking. Most participants were open to a novel, computer-based intervention if the system was easy to use and its animated avatars were culturally appropriate. Because study participants had low exposure to IDM for PrCA, but frequently used ICTs, IDM interventions using ICTs (e.g., computers) hold promise for AA men and should be explored for feasibility and effectiveness. These interventions should aim to increase PrCA screening knowledge and stress the importance of participating in IDM with doctors.
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Salkeld G, Cunich M, Dowie J, Howard K, Patel MI, Mann G, Lipworth W. The Role of Personalised Choice in Decision Support: A Randomized Controlled Trial of an Online Decision Aid for Prostate Cancer Screening. PLoS One 2016; 11:e0152999. [PMID: 27050101 PMCID: PMC4822955 DOI: 10.1371/journal.pone.0152999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Importance Decision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether “personalising” choice within decisions aids leads to better decision quality. Objective To assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test. Design Randomized controlled trial. Setting Australia. Participants 1,970 men aged 40–69 years were approached to participate in the trial. Intervention 1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes. Outcome Measures To determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes. Results 5% of men in the fixed attribute group scored ‘Have a PSA test’ as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months. Conclusions Together, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000723886
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Affiliation(s)
- Glenn Salkeld
- Faculty of Social Sciences, University Of Wollongong, Wollongong, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Michelle Cunich
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Jack Dowie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Manish I. Patel
- Westmead Clinical School, Westmead Hospital, Sydney, NSW, Australia
| | - Graham Mann
- Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
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Impact of a printed decision aid on patients' intention to undergo prostate cancer screening: a multicentre, pragmatic randomised controlled trial in primary care. Br J Gen Pract 2015; 65:e295-304. [PMID: 25918334 DOI: 10.3399/bjgp15x684817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite recommendations against systematic screening for prostate cancer, 70% of patients still request prostate-specific antigen testing. AIM To assess the impact of a decision aid on patients' intention to undergo prostate cancer screening. DESIGN AND SETTING Randomised controlled trial with two-arm parallel groups in 86 general practices in urban and rural areas in France. METHOD 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). CONCLUSION The decision aid improved participants' informed decision making and reduced their intent to undergo prostate cancer screening.
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Gwede CK, Davis SN, Wilson S, Patel M, Vadaparampil ST, Meade CD, Rivers BM, Yu D, Torres-Roca J, Heysek R, Spiess PE, Pow-Sang J, Jacobsen P. Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives. Am J Health Promot 2015; 29:393-401. [PMID: 24968183 PMCID: PMC4277494 DOI: 10.4278/ajhp.130904-qual-463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity. DESIGN A cross-sectional, qualitative study design was used. SETTING Study setting was a cancer center in southwest Florida. PARTICIPANTS The study comprised 44 participants (24 PC patients and 20 unaffected FDRs). METHOD Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods. RESULTS Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than one separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM. CONCLUSION Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway.
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Affiliation(s)
- Clement K. Gwede
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | | | | | - Mitul Patel
- H. Lee Moffitt Cancer Center & Research Institute
| | - Susan T. Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Cathy D. Meade
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Brian M. Rivers
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Daohai Yu
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Javier Torres-Roca
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Randy Heysek
- H. Lee Moffitt Cancer Center & Research Institute
| | - Philippe E. Spiess
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Julio Pow-Sang
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
| | - Paul Jacobsen
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida, College of Medicine, Dept of Oncologic Sciences
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Lewis CL, Adams J, Tai-Seale M, Huang Q, Knowles SB, Nielsen ME, Pignone MP, Walter LC, Frosch DL. A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings. J Gen Intern Med 2015; 30:810-6. [PMID: 25666221 PMCID: PMC4441669 DOI: 10.1007/s11606-015-3214-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/12/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Decision support interventions (DESIs) provide a mechanism to translate comparative effectiveness research results into clinical care so that patients are able to make informed decisions. Patient decision support interventions for prostate-specific antigen (PSA) have been shown to promote informed decision making and reduce PSA testing in efficacy trials, but their impact in real world settings is not clear. OBJECTIVE We performed an effectiveness trial of PSA decision support interventions in primary care. DESIGN A randomized controlled trial of three distribution strategies was compared to a control. PARTICIPANTS Participants included 2,550 men eligible for PSA testing (76.6 % of the eligible population) and 2001 survey respondents (60.1 % survey response rate). INTERVENTIONS The intervention groups were: 1) mailed the DESI in DVD format, 2) offered a shared medical appointment (SMA) to view the DESI with other men and discuss, and 3) both options. MAIN MEASURES We measured PSA testing identified via electronic medical record at 12 months and DESI use by self-report 4 months after the intervention mailing. KEY RESULTS We found no differences in PSA testing across the three distribution strategies over a year-long follow-up period: 21 %, 24 %, 22 % in the DESI, SMA, and combined group respectively, compared to 21 % in the control group (p = 0.51). Self-reported DESI use was low across all strategies at 4 months: 16 % in the mailed DESI group, 6 % in the SMA group, and 15 % in the combined group (p = < 0.0001). CONCLUSIONS Mailing PSA decision support interventions or inviting men to shared medical appointments unrelated to a primary care office visit do not appear to promote informed decision making, or change PSA testing behavior.
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Affiliation(s)
- Carmen L Lewis
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Mail stop B180, Academic Office 1, Room 8415, 12631 E 17th Ave, Aurora, CO, 80045, USA,
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Ilic D, Jammal W, Chiarelli P, Gardiner RA, Hughes S, Stefanovic D, Chambers SK. Assessing the effectiveness of decision aids for decision making in prostate cancer testing: a systematic review. Psychooncology 2015; 24:1303-1315. [PMID: 25873433 DOI: 10.1002/pon.3815] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/23/2015] [Accepted: 03/07/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prostate cancer is a leading disease affecting men worldwide. Conflicting evidence within the literature provides little guidance to men contemplating whether or not to be screened for prostate cancer. This systematic review aimed to determine whether decision aids about early detection of prostate cancer improve patient knowledge and decision making about whether to undergo prostate-specific antigen testing. METHODS Medline, EMBASE, CINAHL, PsychINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment databases up until March 2014 were searched. All included randomised controlled trials were assessed for methodological quality. Clinical selection and assessment heterogeneity among studies prevented the pooling of data for meta-analyses. Descriptive analyses of all included studies and comparison were performed. RESULTS A total of 13 randomised controlled trials met the inclusion criteria. Significant heterogeneity was present for the design and implementation of decision aids including comparative interventions and outcomes. Eight studies were of a low methodological quality, with the remaining five of medium quality. Improvements in patient knowledge following use of a decision aid were demonstrated by 11 of the 13 included studies. Seven of 10 studies demonstrated a reduction in decisional conflict/distress. Three of four studies demonstrated no difference between a decision aid and information only in reducing decisional uncertainty. Three of five studies demonstrated an increase in decisional satisfaction with use of a decision aid. CONCLUSIONS Decision aids increase patient knowledge and confidence in decision making about prostate cancer testing. Further research into effective methods of implementation is needed. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Walid Jammal
- Western Clinical School, University of Sydney, Sydney, Australia.,School of Medicine, University of Western Sydney, Sydney, Australia
| | - Pauline Chiarelli
- Faculty of Health and Medicine, School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Robert A Gardiner
- School of Medicine, The University of Queensland, Brisbane, Australia.,UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Herston, Australia
| | - Suzanne Hughes
- Cancer Council Australia and Cancer Council NSW, Sydney, Australia
| | - Dana Stefanovic
- Clinical Guidelines Network, Cancer Council Australia, Sydney, Australia
| | - Suzanne K Chambers
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Griffith Health Institute, Griffith University, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia.,Prostate Cancer Foundation of Australia, Sydney, Australia
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