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

Authors

  • Melissa R. Partin PhD,

    Corresponding authorSearch for more papers by this author
  • David Nelson PhD,

  • David Radosevich PhD,

  • Sean Nugent BA,

  • Ann B. Flood PhD,

  • Nancy Dillon RN, PhD,

  • Jeremy Holtzman MD, MPH,

  • Michele Haas BA,

  • Timothy J. Wilt MD, MPH


  • Received from the Center for Chronic Disease Outcomes Research (MRP, DN, SN, ND, MH, TJW), Veterans Affairs Medical Center; Transplant Information Services (DR), Department of Surgery, and Clinical Outcomes Research Center (DR, JH), School of Public Health, University of Minnesota, Minneapolis, Minn; and Center for the Evaluative Clinical Sciences (ABF), Dartmouth Medical School, Hanover, NH.

    A portion of the results included in this manuscript was presented at: (1) the Sixth Annual Minnesota Health Services Research Conference, February 26, 2002, Minneapolis Minn, (2) the 21st Annual VA Health Services Research Meeting, February 2003, Washington, DC, and (3) the 24th Annual Conference on Patient Education jointly sponsored by the Society of Teachers of Family Medicine and the American Academy of Family Physicians, November 23, 2002, Fort Lauderdale, Fla.

Address correspondence and requests for reprints to Dr. Partin: Center for Chronic Disease Outcomes Research (152/2E), Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417 (e-mail: Melissa.partin@med.va.gov).

Abstract

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.

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