RESUMEN
IMPORTANCE: The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions. OBJECTIVE: To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions. DESIGN, SETTING, AND PARTICIPANTS: A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures. INTERVENTION: Random assignment to print-based decision aid (n = 628), web-based interactive decision aid (n = 625), or usual care (UC) (n = 626). MAIN OUTCOMES AND MEASURES: Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening. RESULTS: Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P <.001). At 1 month, the standardized mean difference (Cohen's d) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC (d = 0.33) and print vs UC (d = 0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P = .009) and significantly more web (P = .001) and print (P = .03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P = .06) and web participants (50.4%; P = .10) were not significant. Screening rates at 13 months did not differ significantly among groups. CONCLUSIONS AND RELEVANCE: Both decision aids improved participants' informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00196807.
Asunto(s)
Toma de Decisiones , Detección Precoz del Cáncer/métodos , Conocimientos, Actitudes y Práctica en Salud , Consentimiento Informado , Participación del Paciente , Neoplasias de la Próstata/diagnóstico , Anciano , Técnicas de Apoyo para la Decisión , Estudios de Seguimiento , Humanos , Internet , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Routine symptom and health-related quality of life (HRQOL) assessments can engage patients, give provider feedback, and improve doctor/patient communication. OBJECTIVE: We compared the impact of a technology-assisted symptom monitoring system versus usual care on HRQOL and doctor/patient communication in early-stage prostate cancer (PCa) survivors. METHODS: Men (N = 94) were on average 62-years old, mostly African American (AA; 61.7%), and 10-19 months post-treatment. They were randomized to symptom monitoring plus feedback (SM + F; n = 49) or usual care (UC; n = 45). SM+F participants completed a 12-item telephoneassisted monitoring intervention. All participants completed a baseline and 2 follow-up interviews. RESULTS: Among the SM+F participants, perceptions of the monitoring system were positive: 97.1% endorsed it as easy/very easy to use and 85% felt all patients could benefit from it. At baseline, men reported favorable general and cancer-specific HRQOL and doctor/patient communication, but poorer urinary and sexual function. Although there was no overall impact of the intervention, post hoc exploratory analyses indicated that among AA men, those who received SM+F improved relative to UC on doctor/patient communication (P < .05), general HRQOL (P < .06), and sexual function (P < .05). LIMITATIONS: Variability in survivor follow-up care, limited access to eligible participants, and minimal physician training in the use of reports likely decreased physician investment. CONCLUSION: Overall, PCa survivors were receptive to this monitoring system. Exploratory analyses suggest that this technology-assisted monitoring system may be of particular benefit to African American men. Additional studies with larger samples, more intervention time-points, and increased physician training are needed to strengthen the intervention's impact.
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Monitoreo Fisiológico/métodos , Neoplasias de la Próstata/diagnóstico , Anciano , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/instrumentación , Calidad de Vida , Autoinforme , Sobrevivientes/psicología , TeléfonoRESUMEN
BACKGROUND: The impact of lung cancer screening on smoking behavior is unclear. The aims of this ancillary study of the Prostate Lung Colorectal and Ovarian Cancer Screening Trial were to produce risk prediction models to identify individuals at risk of relapse or continued smoking and to evaluate whether cancer-screening variables affect long-term smoking outcomes. METHODS: Participants completed a baseline questionnaire at trial enrollment and a supplemental questionnaire 4-14 years after enrollment, which assessed several cancer-related variables, including family history of cancer, comorbidities, and tobacco use. Multivariable logistic regression models were used to predict smoking status at completion of the supplemental questionnaire. The models' predictive performances were evaluated by assessing discrimination via the receiver operator characteristic area under the curve (ROC AUC) and calibration. Models were internally validated using bootstrap methods. RESULTS: Of the 31 694 former smokers on the baseline questionnaire, 1042 (3.3%) had relapsed (ie, reported being a current smoker on the supplemental questionnaire). Of the 6807 current smokers on the baseline questionnaire, 4439 (65.2%) reported continued smoking on the supplemental questionnaire. Relapse was associated with multiple demographic, medical, and tobacco-related characteristics. This model had a bootstrap median ROC AUC of 0.862 (95% confidence interval [CI] = 0.858 to 0.866) and a calibration slope of 1.004 (95% CI = 0.978 to 1.029), indicating excellent discrimination and calibration. Predictors of continued smoking also included multiple demographic, medical, and tobacco-related characteristics. This model had an ROC AUC of 0.611 (95% CI = 0.605 to 0.614) and a slope of 1.006 (95% CI = 0.962 to 1.041), indicating modest discrimination. Neither the trial arm nor the lung-screening result was statistically significantly associated with smoking outcomes. CONCLUSION: These models, if validated externally, may have public health utility in identifying individuals at risk for adverse smoking outcomes, who may benefit from relapse prevention and smoking cessation interventions.
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Neoplasias Colorrectales/mortalidad , Detección Precoz del Cáncer , Neoplasias Pulmonares/mortalidad , Neoplasias Ováricas/mortalidad , Neoplasias de la Próstata/mortalidad , Fumar/efectos adversos , Fumar/epidemiología , Adulto , Anciano , Área Bajo la Curva , Ensayos Clínicos como Asunto , Neoplasias Colorrectales/etiología , Neoplasias Colorrectales/prevención & control , Comorbilidad , Supervivencia sin Enfermedad , Femenino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/prevención & control , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Análisis Multivariante , Neoplasias Ováricas/etiología , Neoplasias Ováricas/prevención & control , Valor Predictivo de las Pruebas , Neoplasias de la Próstata/etiología , Neoplasias de la Próstata/prevención & control , Curva ROC , Recurrencia , Cese del Hábito de Fumar , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
Most medical organizations recommend informed decision making before undergoing prostate cancer screening. The authors conducted a detailed evaluation of men's use of an interactive, Web-based prostate cancer screening decision aid. Participants (N = 531) were 57 years old (SD = 6.8), 37% were African American, and 92% had Internet access. Men completed 2 telephone interviews, pre- and 1-month post-Web site availability. Half of the sample (n = 256) accessed the Web site. Multivariate analysis revealed that users were more likely than nonusers to be White (OR = 2.37, CI 1.6-3.6), previously screened (OR = 2.13, CI 1.07-4.26), have Internet access (OR = 3.66, CI 1.15-11.58), and to report daily Internet use (OR = 2.58, CI 1.47-4.55). Agreement between self-reported and actual Web site use was moderate (κ = .67). Tracking software revealed a mean of 1.3 (SD = 0.5) log-ons and a median of 38 min per log-on. Of participants, 84% used the values clarification tool, and more than 50% viewed each video testimonial. Baseline screening preference was associated with values clarification tool responses and Web site feedback. This study revealed that, beyond the digital divide, Web site use depended on more than Internet access. Further, electronic tracking of Web site use demonstrated overestimation of self-reported use, high use of interactive features, and effect of baseline screening preference on men's response to the Web site.
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Técnicas de Apoyo para la Decisión , Detección Precoz del Cáncer , Internet/estadística & datos numéricos , Neoplasias de la Próstata/prevención & control , Anciano , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Factores Socioeconómicos , Interfaz Usuario-ComputadorRESUMEN
BACKGROUND: Evidence suggests that colorectal cancer (CRC) screening reduces disease-specific mortality, whereas the utility of prostate cancer screening remains uncertain. However, adherence rates for prostate cancer screening and CRC screening are very similar, with population-based studies showing that approximately 50% of eligible US men are adherent to both tests. Among men scheduled to participate in a free prostate cancer screening program, the authors assessed the rates and correlates of CRC screening to determine the utility of this setting for addressing CRC screening nonadherence. METHODS: Participants (N = 331) were 50 to 70 years old with no history of prostate cancer or CRC. Men registered for free prostate cancer screening and completed a telephone interview 1 to 2 weeks before undergoing prostate cancer screening. RESULTS: One half of the participants who underwent free prostate cancer screening were eligible for but nonadherent to CRC screening. Importantly, 76% of the men who were nonadherent to CRC screening had a regular physician and/or health insurance, suggesting that CRC screening adherence was feasible in this group. Furthermore, multivariate analyses indicated that the only significant correlates of CRC screening adherence were having a regular physician, health insurance, and a history of prostate cancer screening. CONCLUSIONS: Free prostate cancer screening programs may provide a teachable moment to increase CRC screening among men who may not have the usual systemic barriers to CRC screening, at a time when they may be very receptive to cancer screening messages. In the United States, a large number of men participate in annual free prostate cancer screening programs and represent an easily accessible and untapped group that can benefit from interventions to increase CRC screening rates.