Veteran Peer Navigators to Promote Shared Decision Making for PSA Screening
NCT Number: NCT06549036
Status: NOT_YET_RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Prostate Cancer
Interventions: BEHAVIORAL: Veteran Peer Decision Coaching Session for PSA Screening
Sponsor: VA Office of Research and Development
Sex: MALE
Age: ADULT, OLDER_ADULT
Enrollment: 228
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: DOUBLE (CARE_PROVIDER, INVESTIGATOR)|Primary Purpose: SCREENING
Start Date: 2024-11-01
Completion Date: 2028-08-31
Locations: VA NY Harbor Healthcare System, New York, NY, New York, New York, 10010-5011, United States

Summary:
The project will investigate the efficacy of a Veteran-peer-navigator-led decision coaching (PDC) program to promote Shared Decision Making (SDM) for prostate cancer screening among Veterans at the Veterans Health Administration (VA). Prostate cancer is commonly screen detected using PSA, a non-specific test which has led to modest population-level survival benefits at the cost of over-detection of low-risk disease. This trade off in outcomes is ideally addressed using SDM which can be challenging to implement in time constrained primary care office visits. The investigators propose the evaluation of a PDC intervention to promote SDM for PSA screening to improve both access and quality of care for Veterans. The investigators results will enhance understanding of the efficacy, cost-effectiveness, and sustainability of PDC interventions for SDM promotion across communication formats in the VA. Lessons learned through this proposal will not only improve quality of care for PSA screening but also will suggest a paradigm for dissemination of SDM across preventive services.

Primary Outcome Measures: Decisional Conflict, The 16-item Decisional Conflict Scale (DCS) measures Veterans' perceptions of 1) uncertainty in choosing options, 2) feelings of having adequate knowledge and clear values, and 3) effective decision making. DCS is scored on a 5-point Likert scales with scores ranging from 0 (no decisional conflict) to 100 (extremely high decisional conflict), Up to 3 months|Patient Knowledge Survey Score, The Patient Knowledge Survey comprises of 12-items assessing prostate cancer and PSA screening knowledge. Respondents provide an answer of "True", "Unsure", or "False". The total score is the sum of correct responses and ranges from 0 - 12 with higher scores indicating greater knowledge levels., Day 1|Decision Quality Score, Decision quality will be measured through 3 domains: 1) decisional conflict 2) being informed (e.g. accurate understanding about screening and its risks and benefits) and 3) making preference-concordant decisions (i.e. treatment consistent with patient preferences). The Decision Quality Balance Scale consists of 12 questions (6 Pros and 6 Cons of testing) scored on a 5 point Likert scale (Strongly Disagree to Strongly Agree) that represents the relative strengths of the pros versus the cons and ranges from -24 to +24. A high quality decision is when patients are both well-informed and making preference-concordant decisions (i.e. treatment consistent with patient preferences as determined by responses to survey questions)., Day 1|Prostate-specific Antigen (PSA) Screening Rates, Percentage of participants who receive at least one PSA screening test. Screening data is collected through patient self-report and electronic health record data., Up to Month 3|Percentage of Participants Who Make Informed Choice (Knowledge Survey + Measure of Informed Choice Attitudes Scale), The percentage of participants who make an informed choice to either undergo or decline PSA testing. Informed choices are those in which:

1. Men with good knowledge and positive measure of informed choice attitudes (\> or = 22) choose to undergo the test OR 2) Men with good knowledge but negative measure of informed choice attitudes (\<22) towards the test, do not undergo the test., Day 1|Measure of Informed Choice Attitudes Scale, The measure of Informed Choice evaluates the screening decision. The 4-item measure consists of items assessing knowledge, attitude towards the screening test, and a record of test uptake. The questions are graded on a 7 point Likert-type scale (1 to 7) with scores ranging from 4 to 28. The median of 22 was taken to classify men's attitudes as positive or negative, with scores 22 or above indicating positive attitudes, and those below 22 indicating negative attitudes., Day 1
Secondary Outcome Measures: Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness (COMRADE), Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness (COMRADE) is a 20-item measure validated for clinical encounters with sub-scales in 1) satisfaction with physician communication and 2) patient confidence in the decision. The scale is graded on a 5 point Likert scale (1 to 5) with a range from 1 to 100 maximum. Higher scores indicate higher satisfaction with communication., Day 1|Doctor-Patient Communication Survey, The Questionnaire Concerning Doctor-Patient Communication Skills is a validated 19 item scale that captures process (greeting, listening) and content (explanations and next steps) aspects of the visit from the provider's and patient's perspectives. The questions are scored on a 5-point Likert scale (1 Strongly Disagree to 5 Strongly Agree) with Higher scores (4-5) indicating satisfaction with provider communication, Day 1|Decision Self-Efficacy, The Decision Self-Efficacy Scale is an 11 item scale measuring self-efficacy to perform informed decision making (e.g. getting needed information, asking questions, expressing opinions, and asking for advice). The questions are scored on a 5-point Likert scale (0 Strongly Disagree to 4 Strongly Agree) and range from 0 (not at all confident) to 100 (very confident)., Day 1|Self-efficacy for Communicating with Provider, Perceived Efficacy in Patient-Physician Interactions is a 10-item scale measuring self-efficacy for communicating with a provider. The questions are scored on a 5-point Likert scale (1 Not at all confident to 5 Very confident) with a range of possible scores from 10 to 50 (highest patient perceived self-efficacy for communicating with provider)., Day 1|Satisfaction with Decision Scale, The SWD is a 6-item measure assessing patient satisfaction with their decision and the decision making process. The questions are scored on a 5-point Likert scale (1 Strongly Disagree to 5 Strongly Agree). Higher scores indicate higher satisfaction with decision (scores range from 1-5)., Up to 3 Months|Decisional Regret Scale, The Decisional Regret Scale is a validated, 5-item scale measuring regret or remorse following a health care decision. Questions are scored on a 5-point Likert scale (5 Strongly Disagree to 1 Strongly Agree). Scores range from 0 (means no regret) to 100 (means high regret)., Up to 3 Months