Perceptions of Shared Decision Making Around Prostate Cancer Screening Discussions: Intention-to-Treat Analysis
| Perception | Control | MD-Ed | MD-Ed vs Control AMD (95% CI) | MD-Ed+A | MD-Ed+A vs Control AMD (95% CI) |
|---|---|---|---|---|---|
| Patient self-report, total patients, No. | 291 | 188 | 102 | ||
| Patients who reported discussing PSA screening, No. (%) | 111 (38) | 78 (41) | 0.03 (−0.05 to 0.12) | 66 (65) | 0.27 (0.14 to 0.40) |
| Overall PSA shared decision making, summed mean score (SD)a | 11.8 (3.0) | 11.4 (3.0) | −0.29 (−1.30 to 0.71) | 12.4 (3.0) | 0.87 (−0.17 to 1.90) |
| PSA shared decision-making, mean score (SD)b | |||||
| Discussed pros and cons of PSA screening | 3.0 (0.7) | 2.9 (0.9) | −0.09 (−0.36 to 0.19) | 3.2 (0.8) | 0.26 (−0.02 to 0.54) |
| Offered me choices about whether to get PSA | 2.8 (0.8) | 2.8 (1.0) | −0.01 (−0.31 to 0.27) | 3.0(0.9) | 0.27 (−0.02 to 0.58) |
| Asked me to state whether I wanted a PSA | 2.8 (0.8) | 2.8 (1.0) | 0.03 (−0.29 to 0.24) | 3.0 (0.9) | 0.32 (−0.006 to 0.64) |
| Took my preferences into account when deciding | 3.1 (0.7) | 2.9 (0.9) | −0.18 (−0.44 to 0.08) | 3.2(0.7) | 0.11 (−0.14 to 0.38) |
| Patient values, mean score (SD)c | |||||
| When faced with an important decision about your health, how important is it that you help decide what to do? | 6.4 (1.2) | 6.5 (0.9) | 0.17 (−0.04 to 0.38) | 6.4 (1.1) | 0.01 (−0.24 to 0.27) |
| How much do you worry about being diagnosed with prostate cancer? | 3.0 (1.6) | 3.2 (1.7) | 0.29 (−0.04 to 0.62) | 2.7 (1.4) | −0.30 (−0.69 to 0.09) |
| How worried would you be if you knew that you had prostate cancer cells in your body, even if they might not cause any harm? | 4.3 (1.8) | 4.5 (1.8) | 0.23 (−0.11 to −0.56) | 3.6 (1.5) | −0.70 (−1.10 to −0.30) |
| How much would it bother you to have some difficulty controlling your urine? | 5.6 (1.4) | 5.7 (1.3) | 0.01 (−0.29 to 0.31) | 5.2 (1.4) | −0.49 (−0.83 to −0.14) |
| How much would it bother you if you could rarely, if ever, get enough of an erection to have sex? | 5.7 (1.7) | 5.6 (1.6) | −0.01 (−0.035 to 0.33) | 5.4 (1.7) | −0.20 (−0.30 to 0.20) |
| Unannounced standardized patient report, No. of visits | 43 | 41 | 36 | ||
| Overall PSA shared decision making, mean score (SD)a | 10.0 (3.1) | 10.2 (3.0) | 0.002 (−1.15 to 1.15) | 10.7 (2.7) | 0.32 (−0.90 to 1.54) |
| PSA shared decision-making, mean score (SD)b | |||||
| Discussed pros and cons of PSA screening | 3.0 (0.9) | 3.1 (0.9) | 0.11 (−0.26 to 0.47) | 3.2 (0.8) | 0.18 (−0.21 to 0.57) |
| Offered me choices about whether to get PSA | 2.7 (1.1) | 2.7 (1.1) | −0.06 (−0.60 to 0.47) | 3.0 (0.9) | 0.25 (−0.30 to 0.80) |
| Asked me to state whether I wanted a PSA | 2.1 (1.0) | 2.0 (0.9) | −0.18 (−0.59 to 0.24) | 2.3 (0.8) | −0.02 (−0.45 to 0.41) |
| Took my preferences into account when deciding | 2.3 (1.0) | 2.4 (1.0) | 0.12 (−0.24 to 0.49) | 2.4 (0.9) | −0.01 (−0.40 to 0.38) |
| Pre-post change in shared deicision making, by physician self-report, No. of physiciansd | 43 | 41 | 36 | ||
| Change in shared decision making, summed mean score (SD)e | 0.2 (1.5) | 0.2 (1.5) | −0.05 (−0.72 to 0.61) | 0.1 (1.5) | −0.10 (−0.77 to 0.56) |
| Physician shared decision making, mean score (SD) | |||||
| How often do you offer your patients choices in their medical care? | 0.1 (0.6) | 0.1 (0.6) | 0.07 (−0.18 to 0.33) | −0.03 (0.6) | −0.11 (−0.37 to 0.15) |
| How often do you discuss the pros and cons of each choice with your patients? | 0.2 (0.7) | 0.0 (0.6) | −0.21 (−0.49 to 0.07) | 0.2 (0.5) | 0.07 (−0.21 to 0.35) |
| How often do you ask your patients to state which choice or option they would prefer? | 0.0 (0.7) | 0.0 (0.6) | −0.02 (−0.34 to 0.30) | 0.0 (0.7) | −0.01 (−0.33 to 0.30) |
| How often do you take your patients’ preferences into account when making treatment decisions? | 0.0 (0.6) | 0.0 (0.6) | 0.09 (−0.20 to 0.38) | −0.1 (0.7) | −0.05 (−0.35 to 0.24) |
| Pre-post change in physician self-reported scores, mean (SD)d | |||||
| With a typical average-risk patient, how much time do you usually spend discussing the risks and benefits of PSA screening? | 0.1 (0.7) | 0.3 (0.6) | 0.18 (−0.13 to 0.49) | 0.6 (0.7) | 0.46 (0.15 to 0.78) |
AMD= adjusted mean difference; MD-Ed = physician education; MD-Ed+A = physician education with patient activation; PSA = prostate-specific antigen. Notes: Between-arm contrasts estimated in mixed-effects models for clustered data, with statistical adjustments for health system site.
↵a Instrument scale derived from Kaplan. Scale scores ranged from 4 = strongly disagree to 16 = strongly agree.
↵b Item scores ranged from 1 = strongly disagree to 4 = strongly agree.
↵c Item scores ranged from 1 = not at all to 7 = a great deal.
↵d Preintervention to postintervention change. Scale scores ranged from 1 = never to 5 = in depth.
↵e Instrument scale derived from Kaplan.