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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Semjonow A, Hense HW, Schlößler K, Simbrich A, Borowski M, Bothe C, Kruse K, Tiedje D, Kuss K, Adarkwah CC, Maisel P, Jendyk R, Kurosinski MA, Gerß J, Heidinger O, Tschuschke C, Becker R, Roobol MJ, Bangma C, Donner-Banzhoff N. Development and Prospective Randomized Evaluation of a Decision Aid for Prostate-specific Antigen-based Early Detection of Prostate Cancer in Men Aged Between 55 and 69Yr: The PSAInForm Trial. Eur Urol 2019; 76:1-3. [PMID: 30665815 DOI: 10.1016/j.eururo.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 11/30/2022]
Abstract
For men interested in early detection of prostate cancer, the potential impact on decisional conflict of a decision aid with or without cost compensation for the prostate-specific antigen test will be investigated.
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Affiliation(s)
- Axel Semjonow
- Prostate Center, University Hospital Muenster, Muenster, Germany.
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Kathrin Schlößler
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany
| | - Alexandra Simbrich
- Institute of Epidemiology and Social Medicine, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Christiane Bothe
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Klaus Kruse
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Dorothee Tiedje
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Kathrin Kuss
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany
| | - Charles Christian Adarkwah
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany; Department of Health Services Research and General Practice, University of Siegen, Siegen, 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, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, Westfalian Wilhelms-University 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 Center, Erasmus University Rotterdam, The Netherlands
| | - Chris Bangma
- Department of Urology, Erasmus University Medical Center, Erasmus University Rotterdam, The Netherlands
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany
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Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel MC, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. [Diagnostic and differential diagnosis of benign prostate syndrome (BPS): guidelines of the German Urologists]. Urologe A 2010; 48:1356-60, 1362-4. [PMID: 19756468 DOI: 10.1007/s00120-009-2066-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel M, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. Therapie des benignen Prostatasyndroms (BPS). Urologe A 2009; 48:1503-16. [DOI: 10.1007/s00120-009-2067-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pohl J, Tschuschke C, Leusmann D, Faber P. ESWL bei Urolithiasis und Urogenitaltuberkulose. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1060429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Liedl B, Gleissner J, Göckel-Beining B, Knopf HJ, Kopp I, Lenk S, Naber K, Tschuschke C, Piechota HJ. Blasenkatheterversorgung bei Pflegebedürftigen: Ein ungelöstes Problem! Urologe A 2005; 44:1369-70, 1372-3. [PMID: 16231164 DOI: 10.1007/s00120-005-0934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- B Liedl
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, München.
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Berges R, Dreikorn K, Höfner K, Jonas U, Laval KU, Madersbacher S, Michel MC, Muschter R, Oelke M, Pientka L, Tschuschke C, Tunn U, Palmtag H, Goepel M, Schalhhäuser K, Göckeel-Beining B, Heidenreich A, Rübben H, Schalkerhäuser K, Thon W, Thüroff J, Weidner W. [Guidelines of German urologists on therapy of benign prostate syndrome]. Urologe A 2003; 42:722-38. [PMID: 12750807 DOI: 10.1007/s00120-003-0318-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tschuschke C, Göckel-Beining B. [Development of pharmacotherapy costs in ambulatory urology. Position of the Leadership Council of the Professional Association of Germany Urology e.V. on development of pharmacotherapy costs]. Urologe A 2003; 42:601-2. [PMID: 12830799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Berges R, Dreikorn K, Höfner K, Jonas U, Laval KU, Madersbacher S, Michel MC, Muschter R, Oelke M, Pientka L, Tschuschke C, Tunn U, Schalkhäuser K, Göckel-Beining B, Heidenreich A, Rübben H, Schalkhäuser K, Thon W, Thüroff J, Weidner W. [Guidelines for German urologists on diagnosis of benign prostate syndrome]. Urologe A 2003; 42:584-90. [PMID: 12715130 DOI: 10.1007/s00120-003-0319-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leusmann DB, Tschuschke C, Stenzinger W. Extracorporeal shock wave lithotripsy of renal calculi in a patient with haemophilia A complicated by a high titre factor VIII inhibitor. Br J Urol 1995; 75:415-6. [PMID: 7735816 DOI: 10.1111/j.1464-410x.1995.tb07364.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- D B Leusmann
- Department of Urology, St Hildegardis Hospital, Köln, Germany
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Abstract
The severe pain of a renal colic is an emergency and requires a fast and sufficient analgesic therapy with few side-effects. The release of the ureteral obstruction is secondary to this initial treatment. Inhibition of prostaglandin synthesis directly interferes with the mechanism of renal colic pain. Dipyrone, indomethacin and diclofenac are the drugs of choice. They should be administered intravenously if possible. Narcotic agents and their derivatives are the second choice. Spasmolytic agents are unnecessary in the treatment of renal colic.
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Affiliation(s)
- C Tschuschke
- Urologische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
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Abstract
In an animal study (7 mongrel dogs) the effects of neuroleptanalgesia (NLA) and combinations of NLA with nitrous oxide (N2O) and isoflurane on the macro- and microcirculation of the liver were investigated. Measurements were made in three steps. After NLA alone the dogs were supplementarily ventilated with nitrous oxide/oxygen at a ratio of 2:1. During the last step, 1 MAC isoflurane was added to the inspired gas. From the portal vein, arterial and mixed-venous systems' hemodynamic parameters, blood gases, and acid-base balance were recorded. As a parameter of oxygenation the tissue PO2 of the liver was measured with a multiwire surface electrode. During NLA stable hemodynamic conditions and a balanced acid-base status were observed. The nitrous oxide combination resulted in an increase of the mean pulmonary artery pressure of 16%. The addition of isoflurane had a negative inotropic effect: The heart index decreased to 74% of the starting value and the total peripheral resistance (TPR) increased by 27%. The summarized PO2 histograms under NLA and NLA/N2O showed arithmetic mean values of 34.1 and 35.2 mm Hg, respectively. The addition of isoflurane resulted in a left shift and a decrease of the mean value to 28.6 mm Hg. This histogram corresponds exactly to the oxygen pressure distribution in the dog liver during piritramide basic anesthesia. It seems that NLA and the combination of NLA/N2O increase the liver perfusion with a higher portal-venous and tissue PO2. This effect can be explained only by a massive change of visceral circulation. It is canceled by the addition of isoflurane.
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Affiliation(s)
- H U Spiegel
- Department of Surgery, Westfaelische Wilhelms-University Muenster, Germany
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