Baseline Attitudes About Prostate Cancer Screening Moderate the Impact of Decision Aids on Screening Rates

Abstract

Background: The impact of decision aids on prostate cancer screening outcomes has been inconsistent. Purpose: We assessed whether pre-existing attitudes moderated the impact of decision aids on screening. Methods: Men aged 45–70 (56.2 % Caucasian, 39.9 % African-American) were randomly assigned to a print decision aid (N = 630), a web decision aid (N = 631), or usual care (N = 632). Telephone interviews assessed pro/con screening attitudes and screening behaviors at baseline, 1-month and 13-months post-randomization. Results: Logistic regression analyses revealed significant arm by attitude interactions: Higher baseline cons scores predicted lower screening in the print (OR = 0.60 (95 % CI: 0.40, 0.92)) and web (OR = 0.61 (95 % CI: 0.40, 0.91)) arms but not in usual care (OR = 1.34 (95 % CI: 0.90, 2.00)). Conclusions: The decision aids amplified the impact of men’s baseline attitudes about limitations of screening: Compared to the usual care arm, men in both decision aid arms were less likely to be screened when they perceived more limitations of screening.