scholarly journals Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid (Preprint)

2018 ◽  
Author(s):  
Peter Scalia ◽  
Glyn Elwyn ◽  
Jan Kremer ◽  
Marjan Faber ◽  
Marie-Anne Durand
Keyword(s):  
Prostate Specific Antigen ◽  
Decision Aid ◽  
Specific Antigen ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Web Based ◽  
Psa Test ◽  
Psa Testing ◽  
Patient Decision ◽  
The Web

BACKGROUND Randomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. OBJECTIVE The objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes. METHODS Data were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference. RESULTS Of all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift. CONCLUSIONS Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.

Prospective evaluation of a new patient decision aid to enhance prostate cancer screening decision-making.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 87-87
Author(s):  
Michael Austin Brooks ◽  
Anita Misra-Hebert ◽  
Alexander Zajichek ◽  
Sigrid V. Carlsson ◽  
Jonas Hugosson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Psa Screening ◽  
Psa Testing ◽  
Patient Decision ◽  
The Impact

87 Background: We previously developed screening nomograms to predict 15-year risk of all-cause mortality, prostate cancer diagnosis, and prostate cancer mortality, and incorporated them into a graphical patient decision aid (PtDA). Our objective was to prospectively recruit primary care patients interested in shared-decision making regarding prostate specific antigen (PSA) screening and assess the impact of individualized counseling using our new PtDA. Methods: 50 patients from one internal medicine practice were enrolled in a single-arm sequential trial design, with face-to-face clinician counseling and questionnaires. Eligibility criteria included men age 50-69 years old and life expectancy > 10 years. Patients were excluded for a personal history of prostate cancer or PSA screening within the prior year. Participants completed baseline questionnaires regarding prior PSA testing, demographic information, health literacy, and the Control Preferences Scale (CPS). They then received standardized counseling (based on large trial and epidemiologic data) regarding PSA screening, followed by individualized counseling using our new PtDA. Participants then made a screening decision, and completed a post decision questionnaire including a Decisional Conflict Scale. Results: The median age was 60 (IQR 54; 65). 41 (82%) had a prior PSA test, while 9 (18%) had not. 42 (84%) of participants received some education beyond high school, 41 (82%) demonstrated high health literacy, and 45 (90%) desired to have an active role in decision-making based on the CPS. After undergoing counseling, 34 (68%) participants chose to undergo initial or repeat PSA screening, 8 (16%) chose against future screening, and 8 (16%) remained uncertain. 45 (90%) participants found individualized counseling using the PtDA more useful than standardized counseling. Finally, patients reported reduced decisional conflict compared to historical controls (P < 0.001). Conclusions: Our process of standardized counseling followed by individualized counseling using our new PtDA was effective in reducing decisional conflict. The majority of participants found the PtDA more useful for decision making than standardized counseling. Clinical trial information: NCT03387527.

Influence of a patient decision aid on decisional conflict related to PSA testing: A structural equation model.

2008 ◽  
Vol 27 (6) ◽  
pp. 711-721 ◽  
Author(s):  
Robert L. Stephens ◽  
Ye Xu ◽  
Robert J. Volk ◽  
Lawrence E. Scholl ◽  
Stephanie L. Kamin ◽  
...  
Keyword(s):  
Structural Equation Model ◽  
Structural Equation ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Equation Model ◽  
Patient Decision Aid ◽  
Psa Testing ◽  
Patient Decision

scholarly journals Decision aid and cost compensation influence uptake of PSA-based early detection without affecting decisional conflict: a cluster randomised trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dorothee Tiedje ◽  
Matthias Borowski ◽  
Alexandra Simbrich ◽  
Kathrin Schlößler ◽  
Klaus Kruse ◽  
...  
Keyword(s):  
Early Detection ◽  
Primary Endpoint ◽  
Decision Aid ◽  
Randomised Trial ◽  
Specific Antigen ◽  
Decisional Conflict ◽  
Cluster Randomised Trial ◽  
Psa Test ◽  
Psa Testing ◽  
Cluster Randomised

AbstractInternational guidelines recommend to inform men about the benefits and harms of prostate specific antigen (PSA) based early detection of prostate cancer. This study investigates the influence of a transactional decision aid (DA) or cost compensation (CC) for a PSA test on the decisional behaviour of men. Prospective, cluster-randomised trial to compare two interventions in a 2 × 2 factorial design: DA versus counselling as usual, and CC versus noCC for PSA-testing. 90 cluster-randomised physicians in the administrative district of Muenster, Germany recruited 962 participants aged 55–69 yrs. in 2018. Primary endpoint: the influence of the DA and CC on the decisional conflict. Secondary endpoints: factors which altered the involvement of the men regarding their decision to take a PSA-test. The primary endpoint was analysed by a multivariate regression model. The choice to take the PSA test was increased by CC and reduced by the DA, the latter also reduced PSA uptake in men who were offered CC. The DA led to an increase of the median knowledge about early detection, changed willingness to perform a PSA test without increasing the level of shared decision, giving participants a stronger feeling of having made the decision by themselves. The DA did not alter the decisional conflict, as it was very low in all study groups. DA reduced and CC increased the PSA uptake. The DA seemed to have a greater impact on the participants than CC, as it led to fewer PSA tests even if CC was granted.Trial registration: German Clinical Trial Register (Deutsches Register Klinischer Studien DRKS00007687). Registered: 06/05/2015. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007687.

scholarly journals The patient perspective on a first raised PSA test

2015 ◽  
Vol 7 (3) ◽  
pp. 213
Author(s):  
Charis Brown ◽  
Fraser Hodgson ◽  
Zuzana Obertova ◽  
Michael Holmes ◽  
Ross Lawrenson
Keyword(s):  
Prostate Specific Antigen ◽  
Patient Perspective ◽  
Care Pathway ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Patient Experiences ◽  
Test Methods ◽  
Psa Test ◽  
Psa Testing ◽  
General Practices

INTRODUCTION: Approximately 350 000 prostate-specific antigen (PSA) tests are undertaken in New Zealand on a quarter of a million men each year. A number of studies have looked at PSA testing done by general practitioners (GPs) and subsequent outcomes. Few have looked at the patient perspective after a raised PSA result. AIM: To explore patient experiences up to and following a raised PSA test. METHODS: Thirty-one general practices within the Midland region were recruited. Community laboratory databases were used to identify all men with a first raised PSA test during 2010. Questionnaires were sent to these men. RESULTS: One hundred and ninety-four (63%) eligible responses were received from 307 eligible men delivered questionnaires. For 54% of men this was their first PSA test. Most men (66%) identified that their PSA test was initiated by their GP. Forty-three percent of men identified having symptoms at the time of their first raised PSA test. A digital rectal examination (DRE) was performed on 73% of men at the time of the test. Fifty-eight percent of men were referred to see a specialist. Maori men were less likely to be referred after a raised PSA. Of all men referred, 61% received a biopsy. DISCUSSION: PSA testing is predominantly initiated by GPs. We found the care pathway is variable for men after an elevated PSA result. Standardisation of the pathway prior to and post diagnosis would assist patients in knowing what to expect and would aid in GP management of men being investigated for prostate cancer. KEYWORDS: Patient care; prostate-specific antigen; screening, opportunistic

scholarly journals Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Robert. A. Bailey ◽  
Michael Pfeifer ◽  
Alicia C. Shillington ◽  
Qing Harshaw ◽  
Martha M. Funnell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Self Efficacy ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Patient Decision

scholarly journals Informed Choice for Participation in Down Syndrome Screening: Development and Content of a Web-Based Decision Aid

2015 ◽  
Vol 4 (3) ◽  
pp. e113 ◽  
Author(s):  
Mette Maria Skjøth ◽  
Helle Ploug Hansen ◽  
Eva Draborg ◽  
Claus Duedal Pedersen ◽  
Ronald F Lamont ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Pregnant Women ◽  
Decision Aid ◽  
Screening Program ◽  
Informed Choice ◽  
Care Providers ◽  
Patient Decision Aid ◽  
Web Based ◽  
Patient Decision ◽  
Down Syndrome Screening

Background In Denmark, all pregnant women are offered screening in early pregnancy to estimate the risk of having a fetus with Down syndrome. Pregnant women participating in the screening program should be provided with information and support to allow them to make an informed choice. There is increasing interest in the use of Web-based technology to provide information and digital solutions for the delivery of health care. Objective The aim of this study was to develop an eHealth tool that contained accurate and relevant information to allow pregnant women to make an informed choice about whether to accept or reject participation in screening for Down syndrome. Methods The development of the eHealth tool involved the cooperation of researchers, technology experts, clinicians, and users. The underlying theoretical framework was based on participatory design, the International Patient Decision Aid Standards (IPDAS) Collaboration guide to develop a patient decision aid, and the roadmap for developing eHealth technologies from the Center for eHealth Research and Disease Management (CeHRes). The methods employed were a systematic literature search, focus group interviews with 3 care providers and 14 pregnant women, and 2 weeks of field observations. A qualitative descriptive approach was used in this study. Results Relevant themes from pregnant women and care providers with respect to information about Down syndrome screening were identified. Based on formalized processes for developing patient decision aids and eHealth technologies, an interactive website containing information about Down syndrome, methods of screening, and consequences of the test was developed. The intervention was based on user requests and needs, and reflected the current hospital practice and national guidelines. Conclusions This paper describes the development and content of an interactive website to support pregnant women in making informed choices about Down syndrome screening. To develop the website, we used a well-structured process based on scientific evidence and involved pregnant women, care providers, and technology experts as stakeholders. To our knowledge, there has been no research on the combination of IPDAS standards and the CeHRes roadmap to develop an eHealth tool to target information about screening for Down syndrome.

scholarly journals Decision Making when Cancer Becomes Chronic: A Decisional Needs Assessment of Medullary Thyroid Cancer Patients’, Families’, and Providers’ Needs for a Web-based Patient Decision Aid (Preprint)

2021 ◽  
Author(s):  
Danielle Shojaie ◽  
Aubri S Hoffman ◽  
Ruth Amaku ◽  
Maria E Cabanillas ◽  
Julie Ann Sosa ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Needs Assessment ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Chronic Phase ◽  
Shared Decision ◽  
Patient Decision Aid ◽  
Web Based ◽  
Patient Decision

BACKGROUND In cancers with a chronic phase, patients and family caregivers may face difficult decisions such as whether to start a novel therapy, whether to enroll in a clinical trial, and when to stop treatment. These decisions are complex, require an understanding of uncertainty, and necessitate consideration of patients’ informed preferences. For some cancers, such as medullary thyroid carcinoma, these decisions may also involve significant out-of-pocket costs and effects on family members. Providers expressed a need for web-based interventions that can be delivered between consultations to provide education and prepare patients and families for discussing these decisions. To ensure these tools are effective, usable, and understandable, studies are needed to identify patients’, families’, and providers’ primary decision-making needs and optimal design strategies for a web-based patient decision aid. OBJECTIVE Following international guidelines for development of a web-based patient decision aid, the objectives of this study were to: 1) engage potential users to guide development; 2) review the existing literature and available tools; 3) assess users’ decision-making experiences, needs, and design recommendations; and 4) identify shared decision-making approaches to address each need. METHODS This study used the Decisional Needs Assessment approach, including creating a Stakeholder Advisory Panel, mapping decision pathways, conducting an environmental scan of existing materials, and administering a decisional needs assessment questionnaire. Thematic analyses identified the current decision-making pathways, unmet decision-making needs, and decision support strategies to meet each need. RESULTS Stakeholders reported wide heterogeneity in decision timing and pathways. Relevant existing materials included two systematic reviews, 9 additional papers, and multiple educational websites, but nothing that met the criteria of a patient decision aid. Patients and family members emphasized needing plain language (46 of 54, 85%), shared decision making (45 of 54, 83%), and help with family discussions (39 of 54, 72%). Additional needs included information about uncertainty, lived experience, and costs. Providers (n = 10) reported needing interventions that address misinformation (9 of 10, 90%), foster realistic expectations (9 of 10, 90%), and address mistrust in clinical trials (5 of 10, 50%). Additional needs included provider tools to support shared decision making. Both groups recommended designing a web-based patient decision aid that can be tailored (64 of 64, 100%) and delivered on a hospital website (53 of 64, 83%), and that focuses on quality of life (45 of 64, 70%) and provides step-by-step guidance (43 of 64, 67%). The study team identified best practices to meet each need, which are presented in the proposed Decision Support Design Guide. CONCLUSIONS Patients, families, and providers report multifaceted decision support needs during the chronic phase of cancer. Web-based patient decision aids are needed that provide tailored support over time, and explicitly address uncertainty, quality of life, realistic expectations, and effects on families.

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