Impact of a printed decision aid on patients' intention to undergo prostate cancer screening: A multicentre, pragmatic randomised controlled trial in primary care

Abstract

Background: Despite recommendations against systematic screening for prostate cancer, 70% of patients still request prostate-specific antigen testing. Aim: To assess the impact of a decision aid on patients' intention to undergo prostate cancer screening. Design and setting: Randomised controlled trial with two-arm parallel groups in 86 general practices in urban and rural areas in France. Method: Males aged 50-75 years were randomised to receive either the decision aid (intervention group) or usual care (control group). The primary outcome was the proportion of patients' intending to undergo prostate cancer screening, assessed immediately after reading the decision aid. The reasons underlying their choice were elicited and the proportion of patients citing each reason to undergo, or not undergo, prostate cancer screening were compared between the two arms. Results: A total of 1170 patients were randomised (588 in the intervention arm) from November 2012 to February 2013. The proportion of patients who intended to be tested for prostate cancer in the intervention arm (123 patients [20.9%]) was significantly reduced compared with the control arm (57 patients [9.8%]) (difference 11.1%, 95% confidence interval [CI] = 7.0 to 15.2, P<0.0001). In the intervention group, a lower proportion of individuals expressed that cancer screening would protect them from the disease, compared with the control group (P<0.0001), while a greater proportion of individuals stated that prostate cancer screening would not benefit their health (P<0.0001) and may involve procedures with harmful side effects (P = 0.0005). Conclusion: The decision aid improved participants' informed decision making and reduced their intent to undergo prostate cancer screening.