Cargando…
Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial
BACKGROUND: 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 ai...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
Gunther Eysenbach
2010
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956331/ https://www.ncbi.nlm.nih.gov/pubmed/20693148 http://dx.doi.org/10.2196/jmir.1305 |
_version_ | 1782188138004742144 |
---|---|
author | Evans, Rhodri Joseph-Williams, Natalie Edwards, Adrian Newcombe, Robert G Wright, Patricia Kinnersley, Paul Griffiths, Jeff Jones, Mari Williams, Janet Grol, Richard Elwyn, Glyn |
author_facet | Evans, Rhodri Joseph-Williams, Natalie Edwards, Adrian Newcombe, Robert G Wright, Patricia Kinnersley, Paul Griffiths, Jeff Jones, Mari Williams, Janet Grol, Richard Elwyn, Glyn |
author_sort | Evans, Rhodri |
collection | PubMed |
description | BACKGROUND: 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 [ρ] = -0.49, P < .001) and lower intention to undergo testing (ρ = -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) |
format | Text |
id | pubmed-2956331 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Gunther Eysenbach |
record_format | MEDLINE/PubMed |
spelling | pubmed-29563312010-10-18 Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial Evans, Rhodri Joseph-Williams, Natalie Edwards, Adrian Newcombe, Robert G Wright, Patricia Kinnersley, Paul Griffiths, Jeff Jones, Mari Williams, Janet Grol, Richard Elwyn, Glyn J Med Internet Res Original Paper BACKGROUND: 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 [ρ] = -0.49, P < .001) and lower intention to undergo testing (ρ = -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) Gunther Eysenbach 2010-08-06 /pmc/articles/PMC2956331/ /pubmed/20693148 http://dx.doi.org/10.2196/jmir.1305 Text en ©Rhodri Evans, Natalie Joseph-Williams, Adrian Edwards, Robert G Newcombe, Patricia Wright, Paul Kinnersley, Jeff Griffiths, Mari Jones, Janet Williams, Richard Grol, Glyn Elwyn. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.08.2010 http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Evans, Rhodri Joseph-Williams, Natalie Edwards, Adrian Newcombe, Robert G Wright, Patricia Kinnersley, Paul Griffiths, Jeff Jones, Mari Williams, Janet Grol, Richard Elwyn, Glyn Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial |
title | Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial |
title_full | Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial |
title_fullStr | Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial |
title_full_unstemmed | Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial |
title_short | Supporting Informed Decision Making for Prostate Specific Antigen (PSA) Testing on the Web: An Online Randomized Controlled Trial |
title_sort | supporting informed decision making for prostate specific antigen (psa) testing on the web: an online randomized controlled trial |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956331/ https://www.ncbi.nlm.nih.gov/pubmed/20693148 http://dx.doi.org/10.2196/jmir.1305 |
work_keys_str_mv | AT evansrhodri supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT josephwilliamsnatalie supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT edwardsadrian supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT newcomberobertg supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT wrightpatricia supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT kinnersleypaul supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT griffithsjeff supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT jonesmari supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT williamsjanet supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT grolrichard supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial AT elwynglyn supportinginformeddecisionmakingforprostatespecificantigenpsatestingonthewebanonlinerandomizedcontrolledtrial |