59 Evaluating two decision AIDS for australian men to support informed choice about prostate cancer screening

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Abstract

Objectives

Prostate-specific antigen (PSA) screening is highly contested, with well-documented harms. Public and professional communication has historically been highly varied and potentially confusing. Government-endorsed Australian guidelines make no recommendation to routinely offer PSA screening, but instead advocate informed decision-making, including advising clinicians to ‘offer evidence-based decisional support to men considering whether or not to have a PSA test’. There is little evidence of widespread adoption of decision support in primary care. This study will assess and compare the acceptability and comprehensibility of two evidence-based decision aids (long and abbreviated) among a community sample of Australian men with varying educational backgrounds.

Method

A community sample of 3000 men aged 45–60 years will be recruited by a company experienced in panel survey sampling to participate in this study. Quota sampling will ensure strong representation of men with lower levels of educational attainment. Men will be randomised to view either the full decision aid (adapted from a mammography decision aid previously evaluated by RCT (Hersch et al., Lancet 2015)) or a new abbreviated version of the decision aid, and then answer standardised questions in an online survey. Analyses will compare the two aids with respect to ease of understanding, acceptability and confidence in decision-making, and men’s attitudes and intentions to screen.

Results

At this time, results of the survey are pending. We will report the percentages of men who find each decision aid understandable and acceptable to use, stratified by level of educational attainment. We will test to see whether understanding and acceptability differ according to whether men have had a PSA test. We will assess, as secondary outcomes, measures of decision quality including decisional conflict (uncertainty in decision making) and informed choice. A well-established measure of informed choice will be used; it combines measures of men’s knowledge, attitudes to PSA testing and intentions to screen to determine the proportion of men who were able to make an informed choice.

Conclusions

A thorough understanding of men’s needs relating to decisions about PSA testing, and assessment of the comprehensibility and usability of materials, are critical elements to the development of a high quality decision aid. This study will provide important evidence regarding the effectiveness of a short summary version compared with a longer, more comprehensive decision aid. Findings of this study will inform the implementation of the decision aid in clinical practice nationally and add to global knowledge on decision aid design and performance.

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