Men Informed on Prostate Cancer Screening Are Less Likely to Proceed with Testing

Contact:
Angela Sharma
Annals of Family Medicine
(913) 269-2269
asharma@aafp.org

LEAWOOD, Kan. - Men who are exposed to educational decision aids have improved knowledge about prostate cancer screening and are less likely to proceed with prostate-specific antigen (PSA) testing, according to a new study in the May/June 2003 issue of Annals of Family Medicine.

"The integration of decision aids into routine clinical practice may be beneficial in promoting informed decision-making," explained the study's lead author Robert J. Volk, Ph.D., from the Baylor College of Medicine in Houston, Texas. "Our findings suggest that in order to be effective, however, these decision aids may need to be tailored to ethnic-group specific concerns and may need to be presented at routine intervals to ensure knowledge retention."

Prostate cancer is the second most common type of cancer found in American men, with an estimated 198,100 new cases and 31,500 deaths attributed to the disease in 2001.  Though some research has shown that early detection of prostate cancer may decrease the mortality rate associated with the disease, uncertainty remains as to the benefits of PSA screening. 

According to background information provided in the study, most national organizations currently support the concept of patient-informed decision-making.  Yet, while numerous past studies have suggested that decision aids can improve knowledge about prostate cancer and can encourage informed decision-making, none have assessed the long-term impact of the decision aid on subsequent screening behaviors.

Through a randomized clinical trial of 160 men, ages 45 to 70 years with no history of prostate cancer, Volk and colleagues evaluated the impact of a videotape decision aid for promoting informed decision-making about prostate cancer screening among primary care patients.  The participants were randomized to view or not to view a 20-minute educational videotape before a routine office visit and were contacted one year after their visit to assess their receipt of prostate cancer screening, their satisfaction with their screening decision and knowledge retention since the baseline assessment.

The researchers found that those who viewed the decision aid had greater knowledge about prostate cancer and were less likely to pursue PSA testing in the year following the initial office visit. "PSA testing was reported by 24 of 70 (34.3 percent) of the intervention subjects and 37 of 67 (55.2 percent) of the control subjects." Significantly, 12 of the intervention subjects indicated that they did not intend to be screened in the following year, as compared to none of the control subjects.

Additionally, the researchers noticed a measurable influence of ethnicity on the decision to be screened.  "African-American men were more likely to have PSA testing (9 of 16, 56.3 percent) than were white men (13 of 46, 28.3 percent)." In their discussion, the researchers suggest that one possible explanation for this finding is that "African-American men may have focused on the portions of the videotape that dealt with ethnicity and prostate cancer risk, wherein increased risk for prostate cancer among these men was presented." The authors suggest that decision aids may need to be tailored to these ethnic-group specific findings.

Regarding knowledge retention, the researchers found that the "intervention subjects were more knowledgeable of prostate cancer screening than were the control subjects, although these differences declined within one year."  Volk, et al, note that this finding "raises the issue of the need for subsequent educational interventions, or boosters, to help patients remain informed as they consider screening in the future."

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Editor's Note: This work was supported by grants from the American Academy of Family Physicians Foundation and the American Academy of Family Physicians; the Bureau of Health Professions, Health Resources and Services Administration; and the Agency for Healthcare Research and Quality.

Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline.  Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians (AAFP), the American Board of Family Practice (ABFP), the Society of Teachers of Family Medicine (STFM), the Association of Departments of Family Medicine (ADFM), the Association of Family Practice Residency Directors (AFPRD) and the North American Primary Care Research Group (NAPCRG).  The journal is published six times per year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials.  A board of directors with representatives from each of the sponsoring organizations oversees the Annals. Complete editorial content and interactive discussion groups can be accessed free of charge on the journal's Web site, www.annfammed.org.