J. Med. Internet Res. - Supporting informed decision making for prostate specific antigen (PSA) testing on the web: an online randomized controlled trial.

Tópicos

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Resumo

CKGROUND: Men considering the prostate specific antigen (PSA) test for prostate cancer, an increasingly common male cancer, are encouraged to make informed decisions, as the test is limited in its accuracy and the natural history of the condition is poorly understood. The Web-based PSA decision aid, Prosdex, was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions.OBJECTIVES: The aim of this study was to evaluate the effect of the Web-based PSA decision aid, Prosdex, on informed decision making.METHODS: A Web-based randomized controlled trial was conducted in South Wales, United Kingdom. Men aged 50 to 75 who had not previously had a PSA test were randomly allocated to two intervention and two control groups. Participants in the intervention groups either viewed Prosdex or were given a paper version of the text. The main outcome measures were the three components of informed decision making: (1) knowledge of prostate cancer and PSA, (2) attitude toward PSA testing, (3) behavior using a proxy measure, intention to undergo PSA testing. Decisional conflict and anxiety were also measured as was uptake of the PSA test. Outcomes were measured by means of an online questionnaire for the Prosdex group, the paper version group, and one of two control groups. Six months later, PSA test uptake was ascertained from general practitioners' records, and the online questionnaire was repeated. Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes (U/mm), line of no effect 0.50.RESULTS: Participants were 514 men. Compared with the control group that completed the initial online questionnaire, men in the Prosdex group had increased knowledge about the PSA test and prostate cancer (U/mn 0.70; 95% CI 0.62 - 0.76); less favourable attitudes to PSA testing (U/mn 0.39, 95% CI 0.31 - 0.47); were less likely to undergo PSA testing (U/mn 0.40, 95% CI 0.32 - 0.48); and had less decisional conflict (U/mn 0.32, 95% CI 0.25 - 0.40); while anxiety level did not differ (U/mn 0.50, 95% CI 0.42 - 0.58). For these outcomes there were no significant differences between men in the Prosdex group and the paper version group. However, in the Prosdex group, increased knowledge was associated with a less favourable attitude toward testing (Spearman rank correlation [rho] = -0.49, P < .001) and lower intention to undergo testing (rho = -0.27, P = .02). After six months, PSA test uptake was lower in the Prosdex group than in the paper version and the questionnaire control group (P = .014). Test uptake was also lower in the control group that did not complete a questionnaire than in the control group that did, suggesting a possible Hawthorne effect of the questionnaire in favour of PSA testing.CONCLUSIONS: Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer. Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing. Prosdex appears to promote informed decision making regarding the PSA test.TRIAL REGISTRATION: ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK).

Resumo Limpo

ckground men consid prostat specif antigen psa test prostat cancer increas common male cancer encourag make inform decis test limit accuraci natur histori condit poor understood webbas psa decis aid prosdex develop part uk prostat cancer risk manag programm order help men make inform decisionsobject aim studi evalu effect webbas psa decis aid prosdex inform decis makingmethod webbas random control trial conduct south wale unit kingdom men age previous psa test random alloc two intervent two control group particip intervent group either view prosdex given paper version text main outcom measur three compon inform decis make knowledg prostat cancer psa attitud toward psa test behavior use proxi measur intent undergo psa test decision conflict anxieti also measur uptak psa test outcom measur mean onlin questionnair prosdex group paper version group one two control group six month later psa test uptak ascertain general practition record onlin questionnair repeat result report term mannwhitney ustatist divid product two sampl size umm line effect result particip men compar control group complet initi onlin questionnair men prosdex group increas knowledg psa test prostat cancer umn ci less favour attitud psa test umn ci less like undergo psa test umn ci less decision conflict umn ci anxieti level differ umn ci outcom signific differ men prosdex group paper version group howev prosdex group increas knowledg associ less favour attitud toward test spearman rank correl rho p lower intent undergo test rho p six month psa test uptak lower prosdex group paper version questionnair control group p test uptak also lower control group complet questionnair control group suggest possibl hawthorn effect questionnair favour psa testingconclus exposur prosdex associ improv knowledg psa test prostat cancer men high level knowledg less favour attitud toward less like undergo psa test prosdex appear promot inform decis make regard psa testtrial registr isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwwwwebcitationorgrtlqnk

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