Internet-Based Education for Prostate Cancer Screening

描述（由申请人提供）：前列腺癌（PCa）是男性的主要癌症诊断，也是男性癌症死亡的第二大原因。然而，筛查无症状男性仍然存在争议，因为在随机试验中尚未证明PCa的早期诊断和治疗可以降低疾病相关死亡率。目前研究的目标是开发和评估广泛使用，易于传播的方法，以帮助男性在PCa筛查方面做出明智的决定。我们将比较一个新的基于网络的，互动的决策支持方法，我们现有的印刷为基础的PCa筛选决策工具，在不同的男性初级保健患者的样本的疗效。大量证据表明，因特网在增加获取和了解保健信息方面的作用日益扩大，需要对基于因特网的干预措施进行系统评价。拟议试验的一个新方面将是我们关注认知偏差，这是限制先前基于信息的干预成功的一个因素。具体而言，我们将评估：1）确认偏差和2）短期后果偏差。在这个为期五年的项目的第一阶段（1-8个月），我们将开发一个互动的，基于互联网的，病人的信息和决策援助。在II期（9-60个月），我们将在一项随机对照试验中评估这种决策辅助的影响，该试验的患者为来自华盛顿地区两家医院的45-70岁男性初级保健患者（N = 1875）。试验组包括：1）基于打印的信息和决策辅助（打印），2）基于网络的信息加交互式决策辅助（网络），以及3）日常护理（UC）。受试者将在基线、基线后1个月和13个月完成结局评估。具体目标是：1.评价提供方法（网络、印刷品和家庭护理）对知识、决策满意度和筛选决策等关键患者结局变量的影响。2.确定调节干预措施对主要结局影响的因素。3.确定干预措施影响知识和决策满意度的机制。在探索性分析中，我们将评估与网络和印刷材料使用相关的因素。这项研究有可能做出一些重大和创新的贡献：1）开发和评估一种广泛传播的方法，对不同的患者群体进行关于有争议的话题的教育，该方法可以适用于其他类似的有争议的问题，2）确定与印刷材料相比，基于网络的材料是否是该年龄组患者教育的可行方法，3）对可能阻碍理解有争议的医疗决策的认知因素的理解，4）确定目标人群中谁从基于网络的干预中受益最多，以及5）简化和针对未来基于网络的教育干预所需的信息。

DESCRIPTION (provided by applicant): 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.