Informed decision making and prostate specific antigen (PSA) testing for prostate cancer: A randomised controlled trial exploring the impact of a brief patient decision aid on men's knowledge, attitudes and intention to be tested

Watson, Eila; Hewitson, Paul; Brett, Joanne; Bukach, Colleen; Evans, Rhodri; Edwards, Adrian; Elwyn, Glyn; Cargill, Anna; Austoker, Joan

doi:10.1016/j.pec.2006.05.005

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Volume 63, Issue 3 , Pages 367-379, November 2006

Informed decision making and prostate specific antigen (PSA) testing for prostate cancer: A randomised controlled trial exploring the impact of a brief patient decision aid on men's knowledge, attitudes and intention to be tested

Eila Watson
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF, United Kingdom
- Corresponding author. Tel.: +44 1865 226 788; fax: +44 1865 226 784.
Paul Hewitson
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF, United Kingdom
Joanne Brett
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF, United Kingdom
Colleen Bukach
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF, United Kingdom
Rhodri Evans
- Centre for Health Sciences Research, Cardiff University, Cardiff, United Kingdom
Adrian Edwards
- Centre for Health Sciences Research, Cardiff University, Cardiff, United Kingdom
Glyn Elwyn
- Centre for Health Sciences Research, Cardiff University, Cardiff, United Kingdom
Anna Cargill
- Centre for Statistics in Medicine, University of Oxford, United Kingdom
Joan Austoker
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Old Rd Campus, Headington, Oxford OX3 7LF, United Kingdom

Received 19 January 2006; received in revised form 27 April 2006; accepted 1 May 2006.

Abstract

Objective

To examine the impact of a brief patient decision aid (pDA) on men's knowledge, attitudes and intention to have a prostate specific antigen (PSA) test. To explore the important predictors of intention to be tested in men who received the brief pDA.

Methods

A brief pDA designed to facilitate informed decision-making for men considering PSA testing was developed for the NHS Prostate Cancer Risk Management Programme. Men aged 40–75 years selected from 11 General Practices in England and Wales were randomised to receive either a mailed copy of the brief pDA and a questionnaire (intervention group), or a questionnaire alone (control group). The questionnaire assessed knowledge, attitudes, perceived risk and intention to have a PSA test and, for the intervention group, their perceptions of the brief pDA.

Results

Nine hundred and ninety of the men who were eligible for the study returned completed questionnaires (response rate=54%). Men who received the brief pDA had significantly higher knowledge scores (p<0.0001) and less positive attitudes (p<0.0001) regarding PSA testing than men in the control group. There was no significant difference between the two groups in intention to be tested within the next 12 months. 87% of men found the brief pDA was easy to read, 94% considered it contained about the right amount of detail and 94% felt the information was presented in a balanced way. Multivariate analysis identified perceived risk (p<0.0001), perceived benefits of PSA testing (p<0.0001), knowledge (p=0.004), attitude (p=0.007) and age (p=0.01) as the most important independent predictors of intention to be tested amongst men in the intervention group.

Conclusion

The brief pDA was shown to dramatically increase men's knowledge of the benefits and risks of the PSA test. Men who received the brief pDA were significantly less positive about the PSA test, although there was no difference between the two groups regarding their intention to be tested within the next year.

Practice implications

This brief pDA could serve as an acceptable and low cost adjunct to counselling by the General Practitioner (GP), and should promote informed decision making regarding the PSA test. Further research is required to ascertain the utility of the decision aid during the consultation.

Keywords: PSA testing, Decision aid, General practice, Informed decision-making, Randomised controlled trial