Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations

Evans, Rhodri; Edwards, Adrian; Brett, Joanne; Bradburn, Mike; Watson, Eila; Austoker, Joan; Elwyn, Glyn

doi:10.1016/j.pec.2004.06.009

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Volume 58, Issue 1 , Pages 13-26, July 2005

Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations

Rhodri Evans
- Department of Primary Care, University of Wales Swansea Clinical School, Singleton Park, Swansea SA2 8PP, UK
- Corresponding author. Tel.: +44 1792 513489; fax: +44 1792 513430.
Adrian Edwards
- Department of Primary Care, University of Wales Swansea Clinical School, Singleton Park, Swansea SA2 8PP, UK
Joanne Brett
- Cancer Research UK Primary Care Education Research Group, Oxford, UK
Mike Bradburn
- Cancer Research UK Medical Statistics Group, Oxford, UK
Eila Watson
- Cancer Research UK Primary Care Education Research Group, Oxford, UK
Joan Austoker
- Cancer Research UK Primary Care Education Research Group, Oxford, UK
Glyn Elwyn
- Department of Primary Care, University of Wales Swansea Clinical School, Singleton Park, Swansea SA2 8PP, UK

Received 10 November 2003; received in revised form 4 May 2004; accepted 5 June 2004.

Abstract

A man’s decision to have a prostate-specific antigen (PSA) test should be an informed one. We undertook a systematic review to identify and appraise PSA decision aids and evaluations. We searched 15 electronic databases and hand-searched key journals. We also contacted key authors and organisations. All decision aids and evaluations that discussed PSA were included, with meta-analyses performed on two outcomes from the evaluations: PSA testing and patient knowledge of PSA and related issues. Seven decision aids and 11 evaluations were included. The meta-analysis showed a significantly reduced probability in PSA testing after a decision aid: −3.5% (95% confidence interval: 0.0 to 7.2%; P = 0.050). There were significant improvements in knowledge within 2 weeks after a decision aid: 19.5% (95% confidence interval: 14.2 to 24.8%; P < 0.001). The effect on knowledge was less pronounced within 12–18 months after a decision aid: 3.4% (95% confidence interval: −0.7 to 7.4%; P = 0.10). PSA decision aids improve knowledge about PSA testing, at least in the short term. Men given these decision aids seem to be less likely to have the PSA test.

Keywords: PSA, Decision aid