Related Experiment Video
Updated: Jun 7, 2026
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Durable improvements in prostate cancer screening from online spaced education a randomized controlled trial
B Price Kerfoot1, Elizabeth V Lawler, Galina Sokolovskaya
1Veterans Affairs Boston Healthcare System, Massachusetts 02130, USA. price.kerfoot@gmail.com
Context:
Prostate cancer screening with prostate-specific antigen (PSA) is frequently performed, counter to clinical practice guidelines.
Background:
It was hypothesized that an e-mail-based intervention termed "spaced education" could reduce clinicians' inappropriate screening for prostate cancer.
Design:
The study was conducted as an RCT.
Setting/Participants:
The study involved 95 primary care clinicians in eight Veterans Affairs medical centers from January 2007 to February 2009.
Intervention:
Participants were randomized into two cohorts: spaced education clinicians received four isomorphic cycles of nine e-mails over 36 weeks (zero to two e-mails per week), whereas control clinicians received no intervention. Each e-mail presented a clinical scenario and asked whether it was appropriate to obtain a PSA test. Participants received immediate feedback after submitting their answers.
Main Outcome Measures:
The primary outcome was the number and percentage of inappropriate PSA screening tests ordered. Inappropriate testing was defined as use of PSA for prostate cancer screening in patients aged >76 or <40 years. Appropriateness of screening was dichotomized based on patient age at time of screening. Patients with PSA testing for non-screening reasons were excluded using a validated protocol. Logistic regression with adjustment for patient clustering by clinician was performed. Analyses were conducted in 2009.
Results:
During the intervention period (Weeks 1-36), clinicians receiving spaced education e-mails ordered significantly fewer inappropriate PSA screening tests than control clinicians (10.5% vs 14.2%, p=0.041). Over the 72-week period following the intervention (Weeks 37-108), spaced education clinicians continued to order fewer inappropriate tests compared to controls (7.8% vs 13.1%, respectively, p=0.011), representing a 40% relative reduction in inappropriate screening.
Conclusions:
Spaced education durably improves the prostate cancer screening behaviors of clinicians and represents a promising new methodology to improve patient care across healthcare systems.
