The Article in Brief
Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster Randomized Controlled Trial
Michael S. Wilkes , and colleagues
Background Because of controversies surrouding prostate cancer screening, most expert groups recommend shared decision making between patient and doctor. This study tests whether educating primary care physicians and "activating" their patients has a synergistic effect on (1) perceived shared decision making, (2) rates of prostate cancer screening discussion, and (3) final physician prostate cancer screening recommendations.
What This Study Found Pairing a brief 20- to 30-minute Web-based educational intervention for physicians with a companion intervention for patients about counseling for prostate cancer screening appears to improve shared decision making rates and influence physicians' attitudes about screening. Prostate cancer screening discussion rates are higher among patients who receive the combination of physician education and patient activation compared with physician education alone or usual education. Standardized patients (actors trained to simulate real patient cases and later report on the encounter) also report that physicians seeing patients who receive the combined intervention are more likely to be neutral in their final recommendations about whether the patient should obtain a prostate-specific antigen blood test This shift in physicians' attitudes from a pro-screening bias to neutral counseling persists 3 months after the intervention. There is no difference in patients' ratings of shared decision making between the groups.
Implications
- Coupling physician education with patient activation, the authors conclude, has the potential to encourage shared decision making around issues of medical uncertainty, such as prostate cancer screening, and improve the appropriate utilization of medical services.