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A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care

Carmen L Lewis1, Jared Adams, Ming Tai-Seale

  • 1Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Mail stop B180, Academic Office 1, Room 8415, 12631 E 17th Ave, Aurora, CO, 80045, USA, Carmen.L.Lewis@ucdenver.edu.

Journal of General Internal Medicine
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Summary

Decision support interventions for prostate-specific antigen (PSA) testing did not change testing behavior in primary care. Patient education materials, whether mailed or discussed in group appointments, showed no significant impact on PSA screening rates.

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Area of Science:

  • Health Services Research
  • Preventive Medicine
  • Patient Education

Background:

  • Decision support interventions (DESIs) translate research into clinical practice for informed patient choices.
  • Previous trials showed DESIs for prostate-specific antigen (PSA) reduced testing, but real-world effectiveness is unknown.

Purpose of the Study:

  • To evaluate the effectiveness of PSA decision support interventions in a primary care setting.
  • To compare three distribution strategies for delivering PSA DESIs to eligible men.

Main Methods:

  • A randomized controlled trial compared mailed DESIs (DVD), shared medical appointments (SMAs), and a combined approach against a control group.
  • 2,550 men eligible for PSA testing were included, with 2001 survey respondents (60.1% response rate).
  • Prostate-specific antigen testing was tracked via electronic medical records at 12 months; DESI use was self-reported at 4 months.

Main Results:

  • No significant differences in PSA testing rates were observed between the intervention groups (21-24%) and the control group (21%) at 12 months (p = 0.51).
  • Self-reported use of DESIs was low across all strategies: 16% for mailed, 6% for SMA, and 15% for combined groups (p < 0.0001).

Conclusions:

  • Mailed PSA decision support interventions or SMAs, when not integrated into primary care visits, do not effectively promote informed decision-making.
  • These strategies did not alter PSA testing behavior in the studied primary care population.