Internet-Based Education for Prostate Cancer Screening

前列腺癌(PCa)是男性的主要癌症诊断，也是导致 男性癌症死亡。然而，筛查无症状男性仍然存在争议，因为早期诊断和 在一项随机试验中，PCA的治疗尚未显示出与疾病相关的死亡率降低。这个 当前研究的目标是开发和评估可广泛使用、易于传播的方法，以帮助 男性在做出关于PCA筛查的明智决定方面的作用。我们将比较一种新的基于网络的 我们现有的基于打印的PCA筛选决策工具的交互式决策支持方法，其中 男性初级保健患者样本多样化。大量证据表明， 互联网在增加对卫生信息的获取和了解方面的作用，并需要系统化 对基于互联网的干预措施的评价。拟议试验的一个新方面将是我们对认知能力的关注 偏见是限制以往以信息为基础的干预措施成功的一个因素。具体来说，我们 将评估：1)确认偏差和2)短期后果偏差。 在这个五年计划的第一阶段(1-8个月)，我们将开发一个互动的、基于互联网的、 患者信息和决策辅助。在第二阶段(9-60个月)，我们将评估这一决定的影响 对来自两个华盛顿特区的45-70岁男性初级保健患者进行的随机对照试验的援助 地区医院(N=1875)。试验武器包括：1)基于印刷的信息和决策辅助(印刷)，2)网络- 基于信息和交互式决策辅助(Web)，以及3)日常护理(UC)。所有科目都将完成 在基线、基线后1个月和13个月进行结果评估。具体目标是：1.评估 分娩方式(网络与打印与日常护理)对以下关键患者结局变量的影响 知识、决策满意度和筛选决策。2.找出缓和经济衰退的因素 干预措施对主要结果的影响。3.确定干预措施产生影响的机制 知识和决策满意度。在探索性分析中，我们将评估与以下因素相关的因素 使用网络和印刷材料。这项研究有可能使几个有意义和创新性的 贡献：1)开发和评估一种可广泛传播的教育方法 不同群体的患者关于一个有争议的话题，这可以改编成其他类似的 有争议的问题，2)确定基于Web的材料是否是患者可行的方法 对这一年龄段人群的教育，与印刷材料相比，3)对认知因素的理解 妨碍对有争议的医疗决定的理解，4)确定目标中的谁 人口从基于网络的干预中受益最大，以及5)简化所需的信息 并针对未来的基于网络的教育干预。

Prostate cancer (PCa) is the leading cancer diagnosis among men and the second leading cause of male cancer death. However, screening asymptomatic men remains controversial, as early diagnosis and treatment of PCa has not yet demonstrated reduced disease-related mortality in a randomized trial. The goal of the current study is to develop and assess widely accessible, easily disseminable methods to assist men in making informed decisions about PCa screening. We will compare the efficacy of a new web-based, interactive decision support approach to our existing print-based PCa screening decision tool, among a diverse sample of male primary care patients. Abundant evidence documents the expanding role of the Internet in increasing access to and understanding of health information and the need for systematic evaluations of Internet-based interventions. A novel aspect of the proposed trial will be our focus on cognitive biases as a factor that has limited the success of previous information-based interventions. Specifically, we will evaluate: 1) confirmation bias and 2) short-term consequences bias. In Phase I (months 1-8) of this five-year project, we will develop an interactive, Internet-based, patient information and decision aid. In Phase II (months 9-60), we will evaluate the impact of this decision aid in a randomized controlled trial with male primary care patients aged 45-70 from two Washington DC area hospitals (N = 1875). Trial arms include: 1) print-based information and decision aid (Print), 2) web- based information plus interactive decision aid (Web), and 3) usual care (UC). Subjects will complete outcome assessments at baseline, one- and 13-months post-baseline. The specific aims are to: 1. Evaluate the impact of the delivery method (Web vs. Print vs. Usual Care) on the key patient outcome variables of knowledge, decisional satisfaction, and the screening decision. 2. Identify factors that moderate the interventions' impact on the primary outcomes. 3. Identify the mechanisms by which the interventions impact knowledge and decisional satisfaction. In exploratory analyses, we will evaluate factors that are related to use of the web and print materials. This research has the potential to make several significant and innovative contributions: 1) the development and evaluation of a widely-disseminable method of educating a heterogeneous group of patients about a controversial topic, which can be adapted for other similarly contentious issues, 2) a determination of whether Web based materials are a feasible method of patient education for this age cohort, compared to print materials, 3) an understanding of cognitive factors that may hinder comprehension of a controversial medical decision, 4) a determination of who among the target population benefits the most from a web-based intervention, and 5) the information required to streamline and target future web-based educational interventions.