A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings
A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings
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DOI：
10.1007/s11606-015-3214-9
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发表时间：
2015-06-01
影响因子：
5.7
通讯作者：
Frosch, Dominick L.
中科院分区：
文献类型：
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作者：
Lewis, Carmen L.;Adams, Jared;Frosch, Dominick L.
决策支持干预（DESI）提供了一种机制，将比较有效性的研究结果转化为临床护理，使患者能够做出明智的决定。在疗效试验中，前列腺特异性抗原（PSA）的患者决策支持干预已被证明可促进知情决策并减少PSA检测，但其在真实的世界环境中的影响尚不清楚。我们在初级保健中进行了PSA决策支持干预的有效性试验。将三种分配策略的随机对照试验与对照进行了比较。参与者包括2名，550名男性符合PSA检测条件（占符合资格人口的76.6%）和2001年调查答卷人（调查答复率为60.1%）。干预组为：1）以DVD格式邮寄DESI，2）提供共享医疗预约（SMA）与其他男性一起查看DESI并讨论，和3）两种选择。我们测量了12个月时通过电子病历确定的PSA检测和干预邮寄后4个月通过自我报告确定的DESI使用。我们发现在长达一年的随访期内，三种分发策略的PSA检测没有差异：DESI、SMA和联合组分别为21%、24%和22%，而对照组为21%（p = 0.51）。在4个月时，所有策略中自我报告的DESI使用率均较低：邮寄DESI组为16%，SMA组为6%，联合组为15%（p = < 0.0001）。邮寄PSA决策支持干预措施或邀请男性参加与初级保健办公室访问无关的共享医疗预约似乎不会促进知情决策或改变PSA检测行为。
Decision support interventions (DESIs) provide a mechanism to translate comparative effectiveness research results into clinical care so that patients are able to make informed decisions. Patient decision support interventions for prostate-specific antigen (PSA) have been shown to promote informed decision making and reduce PSA testing in efficacy trials, but their impact in real world settings is not clear.We performed an effectiveness trial of PSA decision support interventions in primary care.A randomized controlled trial of three distribution strategies was compared to a control.Participants included 2,550 men eligible for PSA testing (76.6 % of the eligible population) and 2001 survey respondents (60.1 % survey response rate).The intervention groups were: 1) mailed the DESI in DVD format, 2) offered a shared medical appointment (SMA) to view the DESI with other men and discuss, and 3) both options.We measured PSA testing identified via electronic medical record at 12 months and DESI use by self-report 4 months after the intervention mailing.We found no differences in PSA testing across the three distribution strategies over a year-long follow-up period: 21 %, 24 %, 22 % in the DESI, SMA, and combined group respectively, compared to 21 % in the control group (p = 0.51). Self-reported DESI use was low across all strategies at 4 months: 16 % in the mailed DESI group, 6 % in the SMA group, and 15 % in the combined group (p = < 0.0001).Mailing PSA decision support interventions or inviting men to shared medical appointments unrelated to a primary care office visit do not appear to promote informed decision making, or change PSA testing behavior.