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1 Department of Family Medicine, Fairfax Family Practice Residency, Virginia Commonwealth University, Fairfax, Va
2 Departments of Family Medicine, Epidemiology, and Community Health, Virginia Commonwealth University, Fairfax, Va
3 Departments of Family Medicine and Biostatistics, Virginia Commonwealth University, Fairfax, Va
4 Department of Family Medicine, Shenandoah Valley Family Practice Residency Program, Virginia Commonwealth University, Fairfax, Va
CORRESPONDING AUTHOR: Alex Krist, MD, MPH, Department of Family Medicine, Virginia Commonwealth University, 3825 Charles Stewart Dr, Fairfax, VA 22033 ahkrist{at}vcu.edu
PURPOSE Many clinicians lack resources to engage patients in shared decision making for prostate cancer screening. We sought to evaluate whether previsit educational decision aids facilitate shared decision making.
METHODS This randomized controlled study compared a Web-based and a paper-based decision aid with no previsit education. Men aged 50 to 70 years undergoing a health maintenance examination at a large family practice were enrolled. The primary outcome was patient-reported level of control over the decision to be screened. Secondary outcomes included frequency of screening, patient knowledge, decisional conflict, and time spent discussing screening.
RESULTS A total of 497 men participated (75 control, 196 brochure, 226 Web site). Patients exposed to either aid were no more likely than control patients to report a collaborative decision: 36% of patients in each group reported equally sharing decision responsibility. Exposure to either decision aid increased patients’ involvement in decision making compared with the control condition (Web site, P = .03; brochure, P = .03). Only 46% of control patients reported an active decision-making role, compared with 56% of Web site and 54% of brochure patients. Patients exposed to a decision aid answered a greater percentage of knowledge questions correctly (54% control vs 69% Web site, P <.001, and vs 69% brochure, P <.001) and were less likely to be screened (94% control vs 86% Web site, P = .06, and vs 85% brochure, P = .04).
CONCLUSIONS Patients in the decision aid groups were more informed and more engaged in the screening decision than their control counterparts. Exposure did not promote shared decision-making control, however. Whether shared decision making is the ideal model and how to measure its occurrence are subjects for further research.
Key Words: Prostatic neoplasms • decision making • patient education/methods • guideline adherence/statistics & numerical data • prostate-specific antigen/blood • mass screening/methods • prevention/cancer • information management
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 K. C. Stange On TRACK: Primary Care Opportunities for Filling Unmet Need Ann. Fam. Med, May 1, 2007; 5(3): 270 - 272. [Full Text] [PDF]
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K. C. Stange and W. R. Phillips In This Issue: Real Change Is Real Hard in the Real World Ann. Fam. Med, March 1, 2007; 5(2): 98 - 100. [Full Text] [PDF]
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A. H. Krist, S. H. Woolf, and R. E. Johnson How Physicians Approach Prostate Cancer Screening Before and After Losing a Lawsuit Ann. Fam. Med, March 1, 2007; 5(2): 120 - 125. [Abstract] [Full Text] [PDF]
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