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A Randomized Controlled Trial Comparing Alternative Approaches for Men Considering Prostate Cancer Screening

Dominick L. Frosch, PhD; Vibha Bhatnagar, MD, MPH; Steven Tally, PhD; Charles J. Hamori, MD; Robert M. Kaplan, PhD

Arch Intern Med. 2008;168(4):363-369.

Background  We conducted a randomized controlled trial to evaluate the effects of patient decision support Web sites on decision quality for men considering prostate cancer screening.

Methods  Men older than 50 years (N = 611) were randomly assigned to 1 of 4 Internet conditions: traditional didactic decision aid providing information about prostate-specific antigen (PSA) screening options and outcomes; chronic disease trajectory model for prostate cancer followed by a time–trade-off exercise; both the didactic decision aid and the chronic disease trajectory model; or links to public prostate cancer–specific Web sites from credible sources (control condition). Participants completed questionnaires at baseline and after their physical examination. Primary outcome measures were PSA test choice, prostate cancer treatment preferences, knowledge and concern about prostate cancer, and decisional conflict.

Results  Participants assigned to view public Web sites were less likely to review information (116 participants [76.8%] reviewed) than those assigned to experimental groups (399 [86.7%] reviewed; P = .004). Greater reductions in PSA screening from pretest to posttest were observed among participants assigned to the traditional decision aid (–9.1%) or chronic disease trajectory model (–8.7%), compared with participants assigned to the combination (–5.3%) or control (–3.3%) groups (P = .047). Preferences for watchful waiting increased significantly in all 4 groups (baseline, 219 [35.8%]; follow-up, 303 [66.2%]; P < .001). Knowledge scores were lowest for those assigned to public Web sites (mean [SD] score, 7.49 [0.19] of questions correct) and highest for the traditional decision aid (8.65 [0.18] of questions correct; P = .005).

Conclusion  Public Web sites about prostate cancer provide less effective decision support than a specially designed Internet decision aid.

Author Affiliations: Division of General Internal Medicine and Health Services Research, Department of Medicine (Dr Frosch), and Department of Health Services (Dr Kaplan), University of California, Los Angeles; Department of Family and Preventive Medicine, University of California, San Diego (Drs Bhatnagar and Tally); Health Services Research and Development, Veterans Affairs San Diego Healthcare System (Dr Bhatnagar); and Department of Preventive Medicine, Kaiser Permanente, San Diego (Dr Hamori).