A randomized controlled trial of shared decision making for prostate cancer screening

Objective: To evaluate a patient-educational approach to shared decision ma king for prostate cancer screening. Design: Randomized controlled trial with preoffice visit assessment and 2-w eek follow-up. Setting: University-based family practice center. Patients: Men aged 45 through 70 years with no history of prostate cancer o r treatment for prostate disease (N = 160). Two patients were unavailable f or follow-up. Intervention: Twenty-minute educational videotape on advantages and disadva ntages of prostate-specific antigen (PSA) screening for prostate cancer. Main Outcome Measures: A measure of patients' core knowledge of prostate ca ncer developed for this study, reported preferences for PSA testing, and ra tings of the videotape. Results: Patients' core knowledge at baseline was poor. At 2-week follow-up , subjects undergoing videotape intervention showed a 78% improvement in th e number of knowledge questions answered correctly (P =.001), and knowledge increased about mortality due to early-stage prostate cancer, PSA screenin g performance, treatment-related complications, and disadvantages of screen ing. No overall change was observed for control subjects. At follow-up, 48 (62%) of 78 intervention patients planned to have the PSA test compared wit h 64 (80%) of 80 control patients (18.5% absolute reduction; 95% confidence interval, 4.6%-32.4%; P =.009). Intervention subjects rated favorably the amount of information provided and the clarity, balance, and length of the videotape and would recommend the videotape to others. Conclusions: Patient education regarding the potential benefits and harms o f early detection of prostate cancer can lead to more informed decision mak ing. Incorporating the PSA videotape into the periodic health examination f or asymptomatic men aged 50 years and older is recommended.