Value-Based Decision-Making in Prostate Cancer Early Detection

摘要

This report describes a randomized trial of an intervention designed to facilitate informed decision-making about prostate cancer screening. The study population included 199 adult men in the patient population of a university-based internal medicine practice. Participants completed a baseline survey and were randomly assigned to either a Standard Intervention (SI) Group (n=99) or an Enhanced Intervention (EI) Group (n=100). Men in both groups were mailed a prostate cancer informational booklet. The EI Group was offered a decision counseling session to clarify personal preferences about screening. Six months later, a medical chart audit was performed. Screening utilization was defined in two ways. The primary outcome defined utilization as having both a digital rectal exam (DRE) and a prostate specific antigen (PSA) test. The secondary outcome was defined less strictly to reflect common practice among physicians. It regarded a PSA test, with or without a DRE, as screening. For the primary outcome, the El Group had lower screening rates than the SI Group (8% vs. 12%). For the secondary outcome, the rates were similar (18.0% vs. 18.2% respectively). Neither of these effects was statistically significant. Results of multivariable analyses showed that race was a significant predictor of the secondary outcome (p=0.012).