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
Introduction
Prostate cancer is a major cause of morbidity and mortality in men [1]. Controversy continues to surround the role of PSA screening in the early identification and treatment of localised disease [2], and research efforts have been directed towards establishing effective ways of communicating the potential benefits and risks of PSA testing to men [3], [4], [5], [6], [7], [8]. Current policy in the UK is that any man can have a PSA test “provided he has been given full information about the benefits and limitations of the test” – no formal screening programme is in place [9]. In order to assist men to understand the complexities about PSA testing and make an informed decision about testing, the Prostate Cancer Risk Management Programme (PCRMP) has developed an information pack which has been circulated to all GPs in England and Wales [10]. The information pack includes a brief patient decision aid (pDA) in the form of an A4 written sheet, and the intention is that men who consult their GP about the PSA test receive this sheet and have an opportunity to discuss the issues.
It is increasingly recognised as important that individuals are informed in decisions about their health care, and this extends to decisions about participating in cancer screening [11]. Indeed, various interventions have been developed to promote informed decision making in relation to cancer screening. These interventions are generally consistent in improving individuals’ knowledge about the disease, accuracy of risk perceptions, or knowledge and beliefs about the pros and cons of screening and treatment options [12]. A systematic review of existing PSA testing decision aids concluded that men who received a decision aid were less likely to have a PSA test [13]. A recent Swedish study identified having a positive attitude towards the test [7] as the most important predictor of test uptake. A study from the US identified age, income, employment status, perceived control of health and perceived health status as being related to participation in PSA screening [14], and an Australian study identified age and visiting a doctor for urinary symptoms as significant independent predictors of having a PSA test [15].
We could find no previous published work from the UK addressing men's knowledge and attitudes regarding PSA testing and hence the primary purpose of this study was to examine the impact of the brief pDA on men's knowledge, attitudes and intention to have a PSA test. Of secondary interest was men's views on the acceptability and usefulness of the brief pDA, as well as exploration of factors which might influence intention to have a PSA test in men who received the brief pDA.
Section snippets
Participants and recruitment
Participants were recruited from 11 GP practices in England (Oxfordshire and Hertfordshire) and Wales (Cwmbran and Aberystwyth) between January and August 2004. Men were eligible for the study if they were aged 40 to 75 years, and did not have a history of prostate cancer. The sample was drawn from the practice computerised age-sex registers and was stratified by age group (40–49; 50–59; 60–69; 70–75 years). Participant flow through the study is summarised in Fig. 1. Selected men were
Response rate
One thousand, nine hundred and sixty questionnaires were mailed out. One hundred and seven were returned as undelivered. Six respondents were classed ineligible because they had previously had prostate cancer (n = 4) or they received the wrong intervention (n = 2). A total of 990 completed questionnaires were returned from 1847 eligible men, giving an overall response rate of 53.6% (990/1847). Participant flow is summarised in Fig. 1. The response rate was slightly lower in the brief pDA group than
Discussion
This study has shown that in the UK men's awareness of and knowledge regarding the PSA test and prostate cancer is low, but that their attitudes regarding PSA testing are largely positive. Provision of a brief pDA designed to help men make an informed decision as to whether or not to have a PSA test lead to significant improvements in knowledge, and significantly less positive attitudes about the test. However, there were no significant differences in intention to be tested within the next 12
Acknowledgements
We would like to thank the following GP practices for participating in this study: Bury Knowle Health Centre, Oxford, Oxfordshire; Church Street Practice, Wantage, Oxfordshire; Church Surgery, Aberystwyth, Ceredigion; Cwmbran Village Surgery, Cwmbran, Torfaen; Dolphin House Surgery, Ware, Hertfordhsire; East Oxford Health Centre, Oxford, Oxfordshire; Jericho Health Centre, Oxford, Oxfordshire; 19 Beaumont St., Oxford, Oxfordshire; Summertown Health Centre, Oxford, Oxfordshire; The Surgery,
References (34)
- et al.
Prostate cancer: to screen or not to screen?
Lancet Oncol
(2000) - et al.
Intention to test for prostate cancer
Eur J Cancer
(2005) - et al.
Promoting informed decisions about cancer screening in communities and healthcare systems
Am J Prev Med
(2004) - et al.
Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations
Patient Educ Counsel
(2005) - et al.
Predictors of prostate cancer screening among health fair participants
Public Health
(2005) - et al.
The American Urological Association symptom index for benign prostatic hyperplasia
J Urol
(1992) - et al.
Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom
Prev Med
(2003) - et al.
Information needs of men regarding prostate cancer screening and the effect of a brief decision aid
Patient Educ Counsel
(2004) Prostate CancerStats
(2002)- et al.
Educating men about prostate cancer screening. A randomized trial of a mailed pamphlet
Eff Clin Pract
(2001)