The COMPASs Study: Community Preferences for Prostate cAncer Screening. Protocol for a quantitative preference study

Men's preferences and trade-offs for prostate cancer screening: a discrete choice experiment

OBJECTIVES

Prostate cancer screening using prostate-specific antigen (PSA) remains controversial. In deciding about screening, men must weigh the benefits and harms: little is known about benefit: harm trade-offs men are willing to accept. The objective of this study was to assess men's preferences for PSA screening, and the trade-offs between benefits and harms men are willing to accept when deciding about screening.

METHODS

Preferences of 662 men aged 40-69 were assessed using a discrete choice experiment. PSA screening was described by six attributes: prostate cancer deaths, prostate cancer diagnoses, unnecessary biopsies from false-positive PSA tests, impotence, urinary incontinence/bowel problems and cost. A mixed logit model was used to examine the influence of attributes on men's preferences for PSA testing; benefit: harm trade-offs were also calculated.

RESULTS

Men's preferences were significantly influenced by test characteristics, particularly potential mortality benefit, unnecessary biopsies and likelihood of urinary incontinence or bowel problems; preferences were also influenced by age, prior PSA testing experience and perceived risk of prostate cancer. Men were willing to accept between 65 and 233 of 10 000 extra men with unnecessary biopsies, and between 31 and 72 of 10 000 extra men with incontinence/bowel problems to avoid one prostate cancer death.

CONCLUSIONS

Differences in valuations of attributes and trade-offs acceptable to men of different ages suggest a one size fits all approach to PSA testing, regardless of age, may not reflect men's preferences. Our results can be used by policymakers to ensure screening programmes are in line with men's preferences and by clinicians and patients to facilitate informed discussions of the most relevant benefits and downsides of PSA screening for an individual man.

Informed decision making about prostate cancer testing in predominantly immigrant black men: a randomized controlled trial

BACKGROUND

Decision support interventions have been developed to help men clarify their values and make informed decisions about prostate cancer testing, but they seldom target high-risk black and immigrant men.

PURPOSE

This study evaluated the efficacy of a decision support intervention focused on prostate cancer testing in a sample of predominantly immigrant black men.

METHODS

Black men (N = 490) were randomized to tailored telephone education about prostate cancer testing or a control condition.

RESULTS

Post-intervention, the intervention group had significantly greater knowledge, lower decision conflict, and greater likelihood of talking with their physician about prostate cancer testing than the control group. There were no significant intervention effects on prostate specific antigen testing, congruence between testing intention and behavior, or anxiety.

CONCLUSIONS

A tailored telephone decision support intervention can promote informed decision making about prostate cancer testing in black and predominantly immigrant men without increasing testing or anxiety.

Comparing 3 techniques for eliciting patient values for decision making about prostate-specific antigen screening: a randomized controlled trial

IMPORTANCE

To make good decisions about prostate-specific antigen (PSA) screening, men must consider how they value the different potential outcomes.

OBJECTIVE

To determine the effects of different methods of helping men consider such values.

DESIGN AND SETTING

Randomized trial from October 12 to 27, 2011, in the general community.

PARTICIPANTS

A total of 911 men aged 50 to 70 years from the United States and Australia who had average risk. Participants were drawn from online panels from a survey research firm in each country and were randomized by the survey firm to 1 of 3 values clarification methods: a balance sheet (n = 302), a rating and ranking task (n = 307), or a discrete choice experiment (n = 302).

INTERVENTION

Participants underwent a values clarification task and then chose the most important attribute.

MAIN OUTCOME MEASURES

The main outcome was the difference among groups in the most important attribute. Secondary outcomes were differences in unlabeled test preference and intent to undergo screening with PSA.

RESULTS

The mean age was 59.8 years; most participants were white and more than one-third had graduated from college. More than 40% reported a PSA test within 12 months. The participants who received the rating and ranking task were more likely to report reducing the chance of death from prostate cancer as being most important (54.4%) compared with those who received the balance sheet (35.1%) or the discrete choice experiment (32.5%) (P < .001). Those receiving the balance sheet were more likely (43.7%) to prefer the unlabeled PSA-like option (as opposed to the "no screening"-like option) compared with those who received rating and ranking (34.2%) or the discrete choice experiment (20.2%). However, the proportion who intended to undergo PSA testing was high and did not differ between groups (balance sheet, 77.1%; rating and ranking, 76.8%; and discrete choice experiment, 73.5%; P = .73).

CONCLUSIONS AND RELEVANCE

Different values clarification methods produce different patterns of attribute importance and different preferences for screening when presented with an unlabeled choice. Further studies with more distal outcome measures are needed to determine the best method of values clarification, if any, for decisions such as whether to undergo screening with PSA.