New research shows that how information is presented may impact a patient’s PSA decision-making process
A study evaluating different ways of helping men consider prostate-specific antigen (PSA) screening shows that the patient’s decision-making process was influenced by the format in which information was offered.
“Whether to undergo PSA screening is a difficult decision for middle-aged men,” says Michael Pignone, MD, MPH, study senior author. “Effective prostate cancer screening aids should promote understanding of the benefits and risks involved in deciding whether or not to be screened and should incorporate patient values. Our study evaluated different values clarification methods to determine if there is a difference in men’s decision-making based on how they are asked to think about what factors matter to them. We found that there is a difference, and our findings pave the way for further studies.”
Pignone, a professor of medicine and chief of the division of general internal medicine, and an international team of scientists used 4 key elements to describe PSA screening decision options:
- Effect on prostate cancer mortality
- Risk of biopsy
- Risk of being diagnosed with prostate cancer
- Risk of becoming impotent or incontinent as a result of treatment
These elements were presented in 3 different formats: a balance sheet, a rate and rank system, and hypothetical choices. The balance sheet was a table of relevant features of PSA screening in which PSA screening versus no screening options were labeled, and participants were asked to consider this information as they saw fit. The second group was asked to rate and rank the 4 elements (the options were not labeled PSA screening or no screening). For the third format, participants considered a series of hypothetical choices made up of different levels of these elements. As with the second group, the options to screen or not to screen were not labeled in the hypothetical choices.
The study, published in an online edition of the journal JAMA Internal Medicine, involved 911 men between the ages of 50 and 70 from the United States and Australia with an average risk of developing prostate cancer. Both before and after value clarification, the men were asked to complete questionnaires.
Of the men who completed the balance sheet option, 43.7% chose the screening option. Men were less likely to choose the screening option when completing the rate and rank (34.2%) and hypothetical choices surveys (20.2%).
Pignone says, “What we learned was that how screening information is presented makes a difference in how men view the relative importance of different features of the decision. What this means is that more studies must be completed to determine the best method of value clarification around decision making for PSA screening.”
Source: UNC Health Care.