Randomized Trial Examining the Effect of Two Prostate Cancer Screening Educational Interventions on Patient Knowledge, Preferences, and Behaviors

• Published in: Journal of general internal medicine : JGIM 2004-08, Vol.19 (8), p.835-842
• Main Authors: Partin, Melissa R., Nelson, David, Radosevich, David, Nugent, Sean, Flood, Ann B., Dillon, Nancy, Holtzman, Jeremy, Haas, Michele, Wilt, Timothy J.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; decision making; Gynecology. Andrology. Obstetrics; Health Knowledge, Attitudes, Practice; Humans; Internal medicine; Male; Male genital diseases; Mass Screening; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Original; patient education; Patient Education as Topic - methods; Patient Participation; Patient Satisfaction; Prostate-Specific Antigen; prostatic neoplasms; Prostatic Neoplasms - diagnosis; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1111/j.1525-1497.2004.30047.x

OBJECTIVE:  To assess the effect of video and pamphlet interventions on patient prostate cancer (CaP) screening knowledge, decision‐making participation, preferences, and behaviors. DESIGN:  Randomized, controlled trial. SETTING:  Four midwestern Veterans Affairs medical facilities. PATIENTS/PARTICIPANTS:  One thousand, one hundred fifty‐two male veterans age 50 and older with primary care appointments at participating facilities were randomized and 893 completed follow‐up. INTERVENTIONS:  Patients were randomized to mailed pamphlet, mailed video, or usual care/control. MEASUREMENTS AND MAIN RESULTS:  Outcomes assessed by phone survey 2 weeks postintervention included a 10‐item knowledge index; correct responses to questions on CaP natural history, treatment efficacy, the prostate‐specific antigen (PSA)'s predictive value, and expert disagreement about the PSA; whether screening was discussed with provider; screening preferences; and PSA testing rates. Mean knowledge index scores were higher for video (7.44; P= .001) and pamphlet (7.26; P= .03) subjects versus controls (6.90). Video and pamphlet subjects reported significantly higher percentages of correct responses relative to controls to questions on CaP natural history (63%, 63%, and 54%, respectively); treatment efficacy (19%, 20%, and 5%), and expert disagreement (28%, 19%, and 8%), but not PSA accuracy (28%, 22%, and 22%). Pamphlet subjects were more likely than controls to discuss screening with their provider (41% vs 32%; P= .03) but video subjects were not (35%; P= .33). Video and pamphlet subjects were less likely to intend to have a PSA, relative to controls (63%, 65%, and 74%, respectively). PSA testing rates did not differ significantly across groups. CONCLUSIONS:  Mailed interventions enhance patient knowledge and self‐reported participation in decision making, and alter screening preferences. The pamphlet and video interventions evaluated are comparable in effectiveness. The lower‐cost pamphlet approach is an attractive option for clinics with limited resources.