Research ArticleOriginal Research

Patient Education on Prostate Cancer Screening and Involvement in Decision Making

Alex H. Krist, Steven H. Woolf, Robert E. Johnson and J. William Kerns
The Annals of Family Medicine March 2007, 5 (2) 112-119; DOI: https://doi.org/10.1370/afm.623

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Flowchart of study patients.

    Note: Numbers of patients exclused do not add up to 576 because patients could have more than 1 reason for exclusion, ie, have blood work before examination and decline.

  • Figure 2.
    Figure 2.

    Locus of decision-making control (N = 431).

    Note: The figure shows patient-reported decision-making control by study group. A smaller percentage of control patients reported being in control of their decision making than did Web site patients (P1 = .03) or brochure patients (P2 = .03) when responding to the question, “How was the decision made today on whether to do a PSA blood test? (A) I made the decision on whether to order a PSA test. (B) I made the decision about whether to order a PSA test after seriously considering my doctor’s opinion. (C) My doctor and I shared the responsibility for deciding whether to order a PSA test. (D) My doctor made the final decision about whether to order a PSA test after seriously considering my opinion. (E) My doctor made the decision whether to order a PSA test.” Previsit education did not increase the frequency of a shared locus of decision-making control (choice C).

  • Figure 3.
    Figure 3.

    Patients’ actual and desired locus of decision-making control (N = 431).

    Note: The figure shows the level of concordance between the locus of decision-making control that patients reported and the locus of control that they desired. Concordance did not differ between the 3 study groups (P1 = .41). Participants overall were more likely to report “More patient control than desired” than “More physician control than desired,” however (19% vs 11%, P2 = .003).

Tables

  • Table 1.

    Characteristics of the Study Population by Group (N = 497)

    CharacteristicControl Group (n = 75)Brochure Group (n = 196)Web Site Group (n = 226)
    PSA = prostate-specific antigen.
    Age, median (range), years57 (50–70)57 (50–70)56 (50–70)
    Race, %
        White899092
        African American323
    College education or higher, %848385
    Prior testing for PSA, %637069
    Patients seeing resident physicians, %312731
    Physicians reporting to know which group patient was in, %41623
  • Table 2.

    Additional Characteristics of the Prostate Cancer Screening Decision-Making Process

    CharacteristicControl Group (n = 75)Brochure Group (n = 196)Web Site Group (n = 226)
    PSA = prostate-specific antigen; DCS = Decisional Conflict Scale.
    * Control group: patient-reported vs physician-reported frequency of PSA testing (P = .06).
    † Physician-reported frequency of PSA testing: brochure group vs control group (P = .04).
    ‡ Physician-reported frequency of PSA testing: Web site group vs control group (P = .06).
    § Potential range: 0 to 10.
    || Control vs brochure group (P <.001); control vs Web site group (P <.001).
    Patients reported reviewing educational material before visit, %468885
    PSA test ordered
        Patient report, %858386
        Physician report, %94*85†86‡
    Relative frequency no time (0 minutes) was spent discussing prostate cancer
        Patient report, %2.71.03.1
        Physician report, %1.30.50.9
    Minutes spent discussing prostate cancer
        Patient report, mean (range)5.2 (0–20)5.3 (0–25)5.1 (0–15)
        Physician report, mean (range)4.2 (0–30)3.8 (0–15)3.7 (0–20)
    Number of prostate cancer topics discussed§
        Patient report, mean (range)4.3 (0–10)4.9 (0–10)5.0 (0–10)
        Physician report, mean (range)5.2 (0–10)5.1 (0–10)5.0 (0–10)
    Percentage of knowledge questions patient answered correctly54||6969
    Patient DCS score, mean (range)1.58 (1–3.2)1.54 (1–2.8)1.55 (1–2.7)

Additional Files

  • The Article in Brief

    Patient Education on Prostate Cancer Screening and Involvement in Decision Making

    Alex H. Krist, MD, MPH, and colleagues

    Background National guidelines state that doctors should not screen men for prostate cancer without first discussing potential harms, benefits, and scientific uncertainties about the screening process. This study examines whether patients� review of prostate cancer information before a doctor visit increases the rate at which they share decisions about screening for the disease with their doctor.

    What This Study Found Patients invited to review information about prostate cancer and screening were more informed and more involved in screening decisions than other patients. Paper- and Web-based materials were equally effective in educating patients and involving them in the decision process. Exposure to these materials, however, did not promote a process in which patients and doctors truly shared control of decision making.

    Implications

    • Men who reviewed educational materials were more knowledgeable about prostate cancer and less likely to be screened for it.
    • Providing patients with prostate cancer information can increase their involvement in decision making.
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