Decision Support Interventions (DESI) for Prostate Cancer Screening - Study 1
Condition: Healthy Men Age 50 Who Are Considering PSA Screening
Study type: Interventional

Summary: 
      In this study we will compare 3 strategies for systematic delivery of prostate cancer
      screening decision support interventions (DESI) to usual care and examine their impact on
      screening decisions and subsequent healthcare utilization using a randomized control design.

      We hypothesize men who are given the opportunity to review a DESI by one of the 3 strategies
      will be less likely to opt for prostate cancer screening, and will have lower subsequent
      healthcare utilization than men in the control group.
    

Detailed description: 
      We will use a randomized experimental design to compare the effects of 3 different strategies
      to implement a prostate cancer screening decision support intervention (DESI) with a control
      condition in primary care in 2 clinical systems - PAMF (Palo Alto Medical Foundation) and
      UNC. The primary outcomes of interest are men's screening decisions and their subsequent
      healthcare utilization. Secondary outcomes include the likelihood that they review the DESI
      and their decision-specific knowledge. The 3 strategies selected by the PAMF and UNC health
      systems are: (1) mailing men a DESI in DVD; (2) inviting men to participate in a shared
      (group) medical appointment (SMA) to watch and discuss the DESI with a healthcare provider
      and other men; and (3) providing men options by inviting them to a SMA while also providing
      them a DESI in DVD which they can use individually if they are unable or choose not to attend
      a SMA. The 3 groups will be compared to a control condition that does not receive a DESI but
      will be encouraged to discuss prostate cancer screening with their physician. Because of its
      significantly larger patient population, the PAMF site will also evaluate these outcomes by
      targeting screening-naïve patients on their 50th birthday, when they first become guideline
      eligible to consider prostate cancer screening.
    

Intervention name(s): DESI for home viewing; DESI for viewing at Shared Medical Appointment; Option of SMA and DESI or DESI only
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Decision support intervention is a 31 minute DVD mailed to the patients in all of the experimental groups. The program explains the function and location of the prostate and the nature of prostate cancer, including its associated mortality. Next, the program describes the different tests that are used to detect prostate cancer including the digital rectal exam, prostate specific antigen (PSA) test and prostate biopsy.; Shared medical appointment (SMA) sessions will be led by a mid-level provider. The sessions will begin with an introduction about the importance of making an informed decision about prostate cancer screening. The PSA decision support intervention will be shown and then, after the program, participants will be invited to ask questions or share their thoughts and feelings. At the end of the session, information on how to obtain a PSA screening test will be provided to participants. Men who decide in favor of a PSA test immediately following a SMA will be given a lab order which they can use to have the test performed.; Shared medical appointment (SMA) sessions will be led by a mid-level provider. The sessions will begin with an introduction about the importance of making an informed decision about prostate cancer screening. The PSA decision support intervention will be shown and then, after the program, participants will be invited to ask questions or share their thoughts and feelings. At the end of the session, information on how to obtain a PSA screening test will be provided to participants. Men who decide in favor of a PSA test immediately following a SMA will be given a lab order which they can use to have the test performed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Prostate cancer; Decision support intervention (DESI); Shared medical appointments (SMA); Comparative effectiveness research (CER)