Abstract
PURPOSE We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009).
METHODS We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict.
RESULTS Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was −0.93 (P = <.001) for men and −0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and −0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure.
CONCLUSIONS Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.
- early detection of cancer
- cancer screening
- clinical decision making
- mammography
- prostate cancer
- persuasive interventions
Footnotes
Conflicts of interest: authors report none.
Funding support: Research reported in this article was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (1IP2PI000633).
Disclaimer: The views, statements, and opinions presented in this paper are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.
Previous presentations: This study was presented in part at the North American Primary Care Research Group Annual Meeting, November 9–13, 2013, Ottawa, Ontario, Canada; the North American Primary Care Research Group Annual Meeting, November 21–25, 2014, New York, New York; and the 2015 AcademyHealth Annual Meeting, June 14–16, 2015, Minneapolis, Minnesota.
Supplementary materials: Available at http://www.AnnFamMed.org/content/15/1/48/suppl/DC1/.
- Received for publication March 17, 2016.
- Revision received July 19, 2016.
- Accepted for publication August 9, 2016.
- © 2017 Annals of Family Medicine, Inc.