Printed and Web-Based Decision Aids Improved Informed Decision-Making but Didn’t Alter Screening 


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Amid conflicting recommendations for prostate cancer screening and mixed messages communicated to the public about screening effectiveness, decision aids can assist men in making informed choices. A comparison of two different types of decision aids, one print-based and one Web-based, found that both appear to improve patients’ informed decision-making about prostate cancer screening up to 13 months later, but do not appear to affect actual screening rates, according to a study published in JAMA Internal Medicine.

A total of 1,893 men were randomly assigned to receive a print-based decision aid, a Web-based interactive decision aid, or usual care. The mean age was 56.9 years, and 23.8% of the men had a high school education or less. A slight majority (56.2%) were white, 39.9% were African American, and 3.9% were characterized as other. More than 86.3% had been screened for prostate cancer, almost 60% in the last year. 

The decision aids had identical content and were geared to an eighth-grade reading level. Content included introductory material about the prostate, a description of screening and possible results, and information about treatment options, risks, and adverse effects. Also included were a review of prostate cancer risk factors and encouragement to discuss screening with a physician (but not instructions to make an immediate appointment), a 10-item values clarification tool, and resources for more information. The Web material also featured voice-overs, animation, graphics, and an interactive values clarification tool. Researchers measured the participants’ prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants had prostate cancer screening. 

At 1- and 13-month follow-up, both decision aids resulted in significantly improved prostate cancer knowledge and reduced decisional conflict compared with usual care. At 1 month, high satisfaction was reported by significantly more print (60.4%) than Web participants (52.2%) and significantly more Web and print than usual care participants. At 13 months, differences in the proportion of men reporting high satisfaction among print participants (55.7%) compared with Web participants (50.4%) and those receiving usual care (49.8%) was not significant. Screening rates at 13 months did not differ significantly among groups. 

“The clinical implications of this study include the potential” for these two different types of decision aids “to be easily adopted in real-world practice settings,” the authors wrote. The decision aids “offer neutrality,” since they did not influence the screening decision in either direction compared with usual care, and this “allows patients and providers to individualize the decision,” the authors added. 

Now that the decision aids have demonstrated beneficial effects, these aids need to be delivered to patients in a systematic manner, the researchers advised. “Possible avenues include personal health records, distribution in health-care provider offices, or via the websites of large health-care organizations.”

An accompanying commentary noted that “the lessons of prostate cancer screening should cause us to reexamine our tendency to adopt new screening technologies before obtaining high-quality evidence about the magnitude of benefits and harms. Specifically, we should consider implementing policies that help offset our collective propensity to emphasize potential benefits of cancer screening and deemphasize (or completely ignore) potential harms.” 

Taylor KL, et al: JAMA Internal Medicine. July 29, 2013 (early release online).
Reuland DS, Pignone M: JAMA Internal Medicine. July 29, 2013 (early release online).



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