Making sure men are well-informed about the pros and cons of PSA testing
Posted Jul 04 2010 12:00am
Guidelines from several organizations now suggest that men should be thoroughly informed about the risks and benefits of PSA testing before starting to receive such tests (regardless of frequency) as a means to assess possible risk for prostate cancer.
The problem, of course, is that few physicians are in a position to put aside the 30 minutes or so that are needed to provide a patient with a neutral assessment of those risks and benefits. Computer-assisted telephone counseling (CATC) offers one of several possible mechanisms to educate patients about the risks and benefits of PSA testing; web-based and digital video educational systems offer another.
Constanza et al. have studied the use of CATC as a decision aid for men considering whether to have a PSA test.
Eligible patients were recruited through their primary care providers (PCPs). Interested patients were initially provided with an educational booklet which presented the advantages and disadvantages of being screened and did not advocate either for or against testing. After reviewing the information in the booklet, patients were asked to contact the telephone counseling service. The counselor assessed each patient’s stage of readiness, reviewed information provided in the educational booklet, corrected any knowledge deficits, and helped the patient using a values clarification exercise.
The results claimed for this system included:
A significant increase in knowledge about PSA testing (p < 0.001).
A significant increase in the patients’ satisfaction with their decisions (p < 0.001).
A significant decrease in decisional conflict (p < 0.001).
A general consistency of each patient’s decisions with that patient’s values.
Among those men who, initially, had not made a decision about testing, 83.1 percent had made a decision by the time of the final survey and decisions were split evenly for and against testing. Unfortunately, the abstract of the paper provides no information about the number of men involved in this study.
The authors state that this process provided “realistic, unbiased and effective decision support for men facing a difficult and confusing decision.”
What is certainly true is that very high quality, validated systems that can help individual mento come to appropriate decisions about the pros and cons of prostate cancer testing would be very useful. What is also likely to be the case at present is that there would still be considerable differences of opinion over what consituted unbiased and neutral information as tbe basis for making that decision.
Guidelines from several organizations now suggest that men should be thoroughly informed about the risks and benefits of PSA testing before starting to receive such tests (regardless of frequency) as a means to assess possible risk for prostate cancer.
The problem, of course, is that few physicians are in a position to put aside the 30 minutes or so that are needed to provide a patient with a neutral assessment of those risks and benefits. Computer-assisted telephone counseling (CATC) offers one of several possible mechanisms to educate patients about the risks and benefits of PSA testing; web-based and digital video educational systems offer another.
Constanza et al. have studied the use of CATC as a decision aid for men considering whether to have a PSA test.
Eligible patients were recruited through their primary care providers (PCPs). Interested patients were initially provided with an educational booklet which presented the advantages and disadvantages of being screened and did not advocate either for or against testing. After reviewing the information in the booklet, patients were asked to contact the telephone counseling service. The counselor assessed each patient’s stage of readiness, reviewed information provided in the educational booklet, corrected any knowledge deficits, and helped the patient using a values clarification exercise.
The results claimed for this system included:
Among those men who, initially, had not made a decision about testing, 83.1 percent had made a decision by the time of the final survey and decisions were split evenly for and against testing. Unfortunately, the abstract of the paper provides no information about the number of men involved in this study.
The authors state that this process provided “realistic, unbiased and effective decision support for men facing a difficult and confusing decision.”
What is certainly true is that very high quality, validated systems that can help individual mento come to appropriate decisions about the pros and cons of prostate cancer testing would be very useful. What is also likely to be the case at present is that there would still be considerable differences of opinion over what consituted unbiased and neutral information as tbe basis for making that decision.