BACKGROUND: Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. METHODS: Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Web-based educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening. RESULTS: Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control=38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A=50%, MD-Ed=33%, control=15%; P <.05). Of the male patients, 80% had had previous PSA tests. CONCLUSIONS: Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.
RCT Entities:
BACKGROUND: Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. METHODS: Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Web-based educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening. RESULTS:Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control=38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A=50%, MD-Ed=33%, control=15%; P <.05). Of the male patients, 80% had had previous PSA tests. CONCLUSIONS: Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.
Authors: Christiane Bieber; Jennifer Nicolai; Mechthild Hartmann; Klaus Blumenstiel; Nadja Ringel; Antonius Schneider; Martin Härter; Wolfgang Eich; Andreas Loh Journal: Patient Educ Couns Date: 2009-04-28
Authors: France Légaré; Stéphane Ratté; Dawn Stacey; Jennifer Kryworuchko; Karine Gravel; Ian D Graham; Stéphane Turcotte Journal: Cochrane Database Syst Rev Date: 2010-05-12
Authors: Michele Heisler; Reynard R Bouknight; Rodney A Hayward; Dylan M Smith; Eve A Kerr Journal: J Gen Intern Med Date: 2002-04 Impact factor: 5.128
Authors: Gerald L Andriole; E David Crawford; Robert L Grubb; Saundra S Buys; David Chia; Timothy R Church; Mona N Fouad; Edward P Gelmann; Paul A Kvale; Douglas J Reding; Joel L Weissfeld; Lance A Yokochi; Barbara O'Brien; Jonathan D Clapp; Joshua M Rathmell; Thomas L Riley; Richard B Hayes; Barnett S Kramer; Grant Izmirlian; Anthony B Miller; Paul F Pinsky; Philip C Prorok; John K Gohagan; Christine D Berg Journal: N Engl J Med Date: 2009-03-18 Impact factor: 91.245
Authors: Douglas S Bell; Charles E Harless; Jerilyn K Higa; Elizabeth L Bjork; Robert A Bjork; Mohsen Bazargan; Carol M Mangione Journal: J Gen Intern Med Date: 2008-04-30 Impact factor: 5.128
Authors: Richard L Skolasky; Anica M Maggard; David Li; Lee H Riley; Stephen T Wegener Journal: Arch Phys Med Rehabil Date: 2015-03-28 Impact factor: 3.966
Authors: Catherine Tomko; Kimberly Davis; Samantha Ludin; Scott Kelly; Aaron Stern; George Luta; Kathryn L Taylor Journal: Transl Behav Med Date: 2015-06 Impact factor: 3.046
Authors: Stephanie Navarro; Xiaohui Hu; Aaron Mejia; Carol Y Ochoa; Trevor A Pickering; Leslie Ballas; Albert J Farias Journal: Cancer Causes Control Date: 2022-01-15 Impact factor: 2.506
Authors: France Légaré; Rhéda Adekpedjou; Dawn Stacey; Stéphane Turcotte; Jennifer Kryworuchko; Ian D Graham; Anne Lyddiatt; Mary C Politi; Richard Thomson; Glyn Elwyn; Norbert Donner-Banzhoff Journal: Cochrane Database Syst Rev Date: 2018-07-19
Authors: Kevin Selby; Jacques Cornuz; David Gachoud; Jean-Luc Bulliard; Cristina Nichita; Gian Dorta; Cyril Ducros; Reto Auer Journal: BMJ Open Date: 2016-05-13 Impact factor: 2.692