Translating medical evidence to promote informed health care decisions

Abstract

Objective: To examine the effects of a community-based intervention on decisions about prostate-specific antigen (PSA) screening using multiple measures of informed decision making (IDM).

Data sources/study setting: Nonequivalent control group time series design collecting primary data in late 2004 and 2005.

Study design: We developed a multimodal intervention designed to convey the medical uncertainty about the benefits of PSA screening and early treatment and the limited predictive ability of both the PSA test and pathological specimens collected from prostate biopsy. We examined (1) patients' recognition that there is a decision to be made about PSA screening, (2) prostate cancer knowledge levels, (3) their preferred and actual levels of participation in decision making about screening at three points in time, and (4) screening decision.

Data collection: Baseline data collection occurred in community-based organizations. These organizations served as recruiting sources and as sites for the intervention. We collected follow-up data by mail with telephone reminders.

Principal findings: Our intervention was associated with greater recognition of the PSA test as a decision to be made, levels of knowledge, both preferred and actual levels of involvement in decision making, but did not have an impact on the screening decision.

Conclusions: Community-based interventions can influence key measures of IDM about PSA screening.

Figure 1

Sample Distribution by Intervention Group and Time Point Notes. Baseline numbers are the denominators in all cases.RR, response rate.

Figure 2

Belief That PSA Screening Is a Decision over Time, by Group Notes. (a) Time × intervention group (p<.001) (N = 315).(b) Time × Intervention group (p = .006) (N = 315).

Figure 3

Preferred and Actual Levels of Involvement in PSA Decision by Study Group at Baseline and 12 Months Note. N = 370 for preferred level of involvement and N = 346 for actual level of involvement. Comparisons of preferred involvement at baseline versus 12 months: Prostate Only (p = .009), Men's Health (p = .002), and control (p = .265).