NEW YORK (Reuters Health) - Visiting Web sites that provide general patient information on prostate cancer is not the best way for men to get help deciding whether to be screened for the disease, a new study shows.
Instead, men will benefit most from “decision aid” tools that outline the pros and cons of screening and treatment without supporting one choice over another, Dr. Dominick L. Frosch of the University of California Los Angeles and his colleagues say.
“Contrary to what probably a lot of people perceive, there aren’t really any clear answers about making a decision on whether or not to screen for prostate cancer,” Frosch noted in an interview with Reuters Health. The blood test for prostate specific antigen (PSA) now widely used as a screening tool often results in “false alarms,” he explained, but can also miss some prostate cancers. Because prostate cancer is common and frequently grows very slowly, he added, more men with prostate cancer will die from other causes. In addition, prostate cancer treatments can cause impotence and incontinence.
“When men make a decision about this they really need to have good information so they really understand what the decision is about,” Frosch said. There may be some men who undergo screening but would not be screened if they had more information.
To find out which approach is the most helpful to men facing this choice, Frosch and his team randomly assigned 611 men older than 50 to complete a traditional decision aid consisting of several Internet-based modules presenting the pros and cons of screening and various types of treatment and testimonials from patients and doctors; a “chronic disease trajectory model,” also Internet-based, that demonstrated how various choices might affect a man’s quality of life and survival; a combination of the decision aid and the disease trajectory model; or a control group in which the men were directed to the American Cancer Society and Centers for Disease Control and Prevention Web sites on prostate cancer screening.
The traditional decision aid took 30 to 45 minutes to complete, while the chronic disease trajectory model required about 30 minutes.
After viewing the traditional decision aid or the trajectory model, the men who opted not to have a PSA test were those who had expressed significantly less concern about prostate cancer at the study’s outset, the researchers found.
However, the men in the control group who chose not to have a PSA had expressed just as much concern about prostate cancer as those who did have the test. This suggests, Frosch said, a “worse fit between men’s values and decisions” in the control group.
The men in the control group also scored lowest on a test of their knowledge about prostate cancer, while those in the traditional decision aid group scored highest.
“Men who were sent to our decision aid learned some key facts that were important to know for making a decision about prostate cancer screening that men in the control group didn’t learn,” Frosch said. “Patients really need ‘prescription-strength information’ so that they can make the decisions that are right for them.”
While interest in decision support tools is growing, and some health plans make them available to their members, they are still not widely available, according to Frosch.
SOURCE: Archives of Internal Medicine, February 25, 2008.
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