Clinical Health Updates

PSA testing affected by how information is presented

Clinical Question:
Can the decision made by men regarding PSA testing be affected by the manner in which the information about the test is presented?

Bottom Line:
When men are given detailed and balanced information on prostate testing, many will opt not to have the test. The method of presentation probably is a large determinant of the effect of the information. This study found that a video outlining the risks and benefits of PSA testing resulted in 40%-50% of men deciding against testing. Of course, we don’t know what happened when the men went home; other studies of PSA decision making have shown that spouses have a large role in the decision and often overrule the initial decision of the men (Arch Fam Med 1997;6:72-76).

Reference:
Frosch DL, Kaplan RM, Felitti V. Evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test. J Gen Intern Med 2001;16:391-8.

Study Design:
Non-randomized controlled trial

Synopsis:
California law (Grant H. Kenyon Prostate Cancer Detection Act) requires physicians to inform all patients older than aged 50 years who receive a prostate examination about the availability of the prostate-specific antigen (PSA) test. Physicians are not given guidance on how this information should be presented. The investigators sought to evaluate the effects upon PSA screening rates of informing patients about PSA testing by 2 different techniques. Factorial comparison of discussion versus video formats for presenting information about the PSA test. Patients were recruited through the Health Appraisal screening program in the Department for Preventive Medicine, Kaiser Permanente, San Diego, Calif. Male patients undergoing health appraisal screening participated in 1 of 4 groups providing information about PSA screening: usual care ( n=43), discussion about risks and benefits of PSA ( n=45), shared decision-making video ( n=46), or video plus discussion ( n=42). Participants were sequentially assigned to 1 of the 4 groups. No significant differences in demographics or family history was demonstrated between the groups at the time of group assignment. Participants in the intervention groups rated the information as clear, balanced, and fair. There were significant differences in the number of men requesting a PSA test, with the highest rate in the usual care group (97.7%), followed by discussion (82.2%), video (60.0%), and video plus discussion (50.0%).