Supporting informed decision making for prostate specific antigen (PSA) testing on the web: an online randomized controlled trial.
Supporting informed decision making for prostate specific antigen (PSA) testing on the web: an online randomized controlled trial.
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DOI：
10.2196/jmir.1305
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发表时间：
2010-08-06
影响因子：
7.4
通讯作者：
Elwyn, Glyn
中科院分区：
文献类型：
--
作者：
Evans, Rhodri;Joseph-Williams, Natalie;Elwyn, Glyn
背景技术背景：男性考虑前列腺癌的前列腺特异性抗原（PSA）测试，一种越来越常见的男性癌症，鼓励做出明智的决定，因为测试的准确性有限，并且对疾病的自然史了解甚少。基于网络的PSA决策援助，Prosdex，是英国前列腺癌风险管理计划的一部分，以帮助男性作出明智的decisions. CONTENTIVES：本研究的目的是评估基于网络的PSA决策援助，Prosdex，知情decisions making.METHODS：一个基于网络的随机对照试验进行了在英国南威尔士州。年龄在50到75岁之间，以前没有做过PSA测试的男性被随机分配到两个干预组和两个对照组。干预组的参与者要么查看Prosdex，要么得到一份纸质文本。主要的结果指标是知情决策的三个组成部分：（1）前列腺癌和PSA的知识，（2）对PSA检测的态度，（3）使用代理措施的行为，接受PSA检测的意图。决策冲突和焦虑也被测量为PSA测试的摄取。通过在线问卷对Prosdex组、纸质版组和两个对照组中的一个进行结果测量。六个月后，PSA测试的吸收是从全科医生的记录中确定的，并重复了在线问卷。结果用Mann-Whitney U统计量除以两个样本量的乘积（U/mm），无影响线0.50。结果：参与者为514名男性。与完成初始在线问卷的对照组相比，Prosdex组的男性对PSA测试和前列腺癌的了解有所增加（U/mn 0.70; 95% CI 0.62 - 0.76）;对PSA检测的态度较差（U/mn 0.39，95% CI 0.31 - 0.47）;不太可能接受PSA检测（U/mn 0.40，95% CI 0.32 - 0.48）;决策冲突较少（U/mn 0.32，95%CI 0.25 - 0.40）;而焦虑水平无差异（U/mn 0.50，95%CI 0.42 - 0.58）。对于这些结果，Prosdex组和纸质版组的男性之间没有显著差异。然而，在Prosdex组中，知识的增加与对测试的不太有利的态度（斯皮尔曼等级相关[rho] =-0.49，P <0.001）和接受测试的意愿较低（rho =-0.27，P = 0.02）相关。6个月后，Prosdex组的PSA检测摄取率低于纸质版和问卷对照组（P = 0.014）。测试摄取也低于对照组，没有完成调查问卷比对照组，这表明可能的霍桑效应的问卷有利于PSA testing.CONCLUSIONS：暴露于Prosdex与提高知识的PSA测试和前列腺癌。知识水平高的男性对PSA检测的态度不太好，也不太可能接受PSA检测。Prosdex似乎促进关于PSA测试的知情决策。试验注册：ISRCTN 48473735; http://www.controlled-trials.com/ISRCTN48473735（由WebCite存档，网址为http：//www.webcitation.org/5r1TLQ5nK）。
BACKGROUND: Men considering the prostate specific antigen (PSA) test for prostate cancer, an increasingly common male cancer, are encouraged to make informed decisions, as the test is limited in its accuracy and the natural history of the condition is poorly understood. The Web-based PSA decision aid, Prosdex, was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions.OBJECTIVES: The aim of this study was to evaluate the effect of the Web-based PSA decision aid, Prosdex, on informed decision making.METHODS: A Web-based randomized controlled trial was conducted in South Wales, United Kingdom. Men aged 50 to 75 who had not previously had a PSA test were randomly allocated to two intervention and two control groups. Participants in the intervention groups either viewed Prosdex or were given a paper version of the text. The main outcome measures were the three components of informed decision making: (1) knowledge of prostate cancer and PSA, (2) attitude toward PSA testing, (3) behavior using a proxy measure, intention to undergo PSA testing. Decisional conflict and anxiety were also measured as was uptake of the PSA test. Outcomes were measured by means of an online questionnaire for the Prosdex group, the paper version group, and one of two control groups. Six months later, PSA test uptake was ascertained from general practitioners' records, and the online questionnaire was repeated. Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes (U/mm), line of no effect 0.50.RESULTS: Participants were 514 men. Compared with the control group that completed the initial online questionnaire, men in the Prosdex group had increased knowledge about the PSA test and prostate cancer (U/mn 0.70; 95% CI 0.62 - 0.76); less favourable attitudes to PSA testing (U/mn 0.39, 95% CI 0.31 - 0.47); were less likely to undergo PSA testing (U/mn 0.40, 95% CI 0.32 - 0.48); and had less decisional conflict (U/mn 0.32, 95% CI 0.25 - 0.40); while anxiety level did not differ (U/mn 0.50, 95% CI 0.42 - 0.58). For these outcomes there were no significant differences between men in the Prosdex group and the paper version group. However, in the Prosdex group, increased knowledge was associated with a less favourable attitude toward testing (Spearman rank correlation [rho] = -0.49, P < .001) and lower intention to undergo testing (rho = -0.27, P = .02). After six months, PSA test uptake was lower in the Prosdex group than in the paper version and the questionnaire control group (P = .014). Test uptake was also lower in the control group that did not complete a questionnaire than in the control group that did, suggesting a possible Hawthorne effect of the questionnaire in favour of PSA testing.CONCLUSIONS: Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer. Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing. Prosdex appears to promote informed decision making regarding the PSA test.TRIAL REGISTRATION: ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK).