Shared Decision Making: Prostate Cancer Screening

描述(由申请人提供)：前列腺癌常规筛查与前列腺特异性抗原(PSA)的效用仍然存在很大争议，美国预防服务工作组不建议这样做，尽管它可能在个体患者层面上是合理的。许多初级保健医生(PCP)在订购PSA时没有帮助患者了解相关的风险、益处和下游后果。共享决策(SDM)是高质量护理的重要组成部分，它与积极的健康结果、消费者需求和将患者视为人的道德要求相关。改进SDM的方法包括(1)“患者激活”干预，以增加患者在护理中的参与度；(2)医生干预，以改善咨询过程。我们将测试改善SDM的干预措施是否会提高医生和患者对PSA筛查的知识、技能和态度，并改变PCP PSA筛查做法。在一个独特的公私合作伙伴关系中，我们将在加利福尼亚州的四个医疗系统(加州大学洛杉矶分校、加州大学戴维斯分校、农村医疗网络、Kaiser Permanente)招聘145名初级保健医生。我们将对该州所有主要社会人口区域的初级保健医生和患者进行抽样。PCP将按练习地点随机分组，以控制(纸质课程)或积极干预以前由疾病预防控制中心资助开发的基于网络的互动课程。本课程使用可视化工具、视频片段和其他互动内容来说明有关风险评估、PSA筛选和SDM的关键点。此外，干预地点的患者将随机接受与对照地点的患者相同的小册子，或进一步的积极干预，包括从患者角度出发包含类似内容的CD资助的互动课程。这两个干预组(仅限PCP或医生和患者干预)将在知识、技能和态度方面与对照组进行比较。主要终点将是医生SDM行为的变化(卡普兰量表)。还将评估PCP知识和态度在测试前后的变化，并使用未经宣布的标准化患者评估干预后PCP SDM技能，这些患者向PCP办公室提交PSA测试请求。还将评估测试后患者在知识和态度方面的变化。最后，将评估实际PSA订购行为的任何变化。总而言之，我们将评估教育干预的能力，通过激活/通知患者，以及通过为初级保健医生提供工具来更有效地吸引患者，来改善对患者的护理。如果证明有效，这些基于网络的工具可以很容易地在全国和国际上传播，以改善医生和患者对PSA筛查的知识和态度。

DESCRIPTION (provided by applicant): The utility of routine screening for prostate cancer with prostate specific antigen (PSA), remains highly controversial, and is not recommended by the United States Preventive Services Task Force, although it may be justified at the individual patient level. Many primary care physicians (PCPs) order PSA without helping patients understand the associated risks, benefits and downstream consequences. Shared decision-making (SDM) is an important component of high quality care which correlates with positive health outcomes, consumer demand, and a moral imperative to consider patients as persons. Ways to improve SDM include (1) "patient activation" interventions to increase patient participation in care and (2) physician interventions to improve the consultation process. We will test whether an intervention to improve SDM will improve physician and patient knowledge, skills and attitudes about PSA screening, and change PCP PSA screening practices. In a unique public-private partnership, we will recruit 145 PCPs across four health systems in California (UC Los Angeles, UC Davis, Rural Health Network, Kaiser Permanente). We will sample PCPs and patients from all major socio-demographic areas across the state. PCPs will be randomized by practice site to control (paper curriculum) or active intervention with an interactive web-based curriculum previously developed with funding from the CDC. This curriculum utilizes visual tools, video clip vignettes, and other interactive content to illustrate key points about risk assessment, PSA screening, and SDM.. In addition, patients at intervention sites will be randomized to receive either the same brochure as patients at control sites, or a further active intervention consisting of a CD-funded interactive curriculum covering similar content from a patient perspective. Both intervention groups (PCPonly or physician and patient intervention) will be compared to controls regarding knowledge, skills and attitudes. The primary endpoint will be changes in physician SDM behavior (Kaplan scale). Pre.-and post-test changes in PCP knowledge and attitudes will also be assessed, and post-intervention PCP SDM skills will be assessed using unannounced standardized patients, who present to PCP offices with a request for PSA testing. Post-test patient changes in knowledge and attitudes will also be assessed. Finally, any change in actual PSA ordering behaviors will be assessed. In summary, we will evaluate the ability of an educational intervention to improve the care of patients, both by activating/informing patients, and by providing PCPs with tools to engage patients more effectively. If proven effective, these web-based tools can be easily disseminated around the country, and internationally, to improve knowledge and attitudes about PSA screening among physicians and patients.