Does evidence-based information about screening for prostate cancer enhance consumer decision-making? A randomised controlled trial

J Med Screen. 2003;10(1):27-39. doi: 10.1258/096914103321610789.


Objectives: Efforts to educate men about the controversy surrounding prostate cancer screening are well intended but rarely evaluated rigorously. We evaluated an evidence-based (EB) booklet for men designed to promote informed decision-making. We also determined whether men's preference for involvement in decision-making ("passive", "collaborative" or "active") modified its impact.

Setting and methods: Men aged 40-70 years were recruited from the practices of 13 local general practitioners (GPs) in Sydney, Australia. They completed a self-administered questionnaire before seeing their GP, who, according to pre-randomised codes, distributed either our EB booklet or conventional information. Post-test questionnaires were mailed to men three days later. Of the 248 eligible men recruited, 214 (86% response rate) returned post-test questionnaires. Knowledge of evidence and of risk of developing and dying from prostate cancer, attitudes, interest in screening for prostate-specific antigen (PSA), worry and decisional conflict were the main outcome measures.

Results: Compared with those receiving conventional information, men receiving the EB booklet had significantly improved knowledge (50% of items correct, 95% CI 46-53%; vs 45% correct, 95% CI 42-48%) (p = 0.048) and lower levels of decisional conflict (mean 21.6, 95% CI 20.7-22.5; vs mean 24.3, 95% CI 23.4-25.2) (p < 0.001). Interest in PSA screening was significantly reduced in both groups at post-test (p < 0.001). Men preferring a "passive" approach to decision-making gained as much from our EB booklet as those with "active" or "collaborative" preferences.

Conclusions: Our findings show the benefits of providing evidence-based information to men about PSA screening. Our EB booklet facilitated informed choice, even among "passive" decision-makers.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anxiety
  • Australia / epidemiology
  • Biomarkers, Tumor / blood
  • Decision Making
  • Evidence-Based Medicine / standards*
  • Family Practice
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Incidence
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Patient Education as Topic*
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / epidemiology
  • Prostatic Neoplasms / prevention & control*
  • Prostatic Neoplasms / psychology


  • Biomarkers, Tumor
  • Prostate-Specific Antigen