Review and special articleTrials of Decision Aids for Prostate Cancer Screening: A Systematic Review
Introduction
Prostate cancer is the second leading cause of cancer death in the United States among men older than 50 years.1 Although prostate cancer can be detected early by a prostate-specific antigen (PSA) test together with a digital rectal exam (DRE), uncertainty remains about the ability of screening to reduce prostate cancer mortality.2 This uncertainty has prompted professional organizations to offer guidelines promoting informed decision making about prostate cancer screening.2, 3, 4, 5, 6, 7, 8
The emphasis on informed decision making about prostate cancer screening has resulted in the development of patient-decision–support technologies, or decision aids.9, 10 A decision aid is an intervention “designed to help people make specific and deliberate choices among options (including the status quo) by providing (at a minimum) information on the options and outcomes relevant to a person’s health status.”11 Additional information may also be provided, including probabilities of outcomes that are tailored to the patient’s risk factors and an explicit values-clarification exercise.10 Previous systematic reviews of decision aid studies generally have concluded that decision aids improve knowledge, instill more realistic expectations, lessen decisional conflict, and reduce the proportion of patients assuming a passive role in the decision process.10
As decision aids for prostate cancer screening continue to proliferate, few are being evaluated in comparative trials. Presented here is a systematic review of studies that have evaluated decision aids for prostate cancer screening. It updates a Cochrane review through early 200110 and a review covering studies of aids for prostate cancer screening through 2003.12 Specifically, it examines the types of decision aids evaluated, describes the methods used to evaluate how the aids affected decision making and to measure the outcomes, and summarizes primary findings from the evaluations.
Section snippets
Literature Search and Data Abstraction
MEDLINE was searched with the key words “prostate cancer screening” and “decision making” for articles published through December 2006. A 2003 Cochrane review,10 a 2002 evidence report by the Agency for Healthcare Research and Quality,13 and a review by Evans et al.12 were examined to identify studies on prostate cancer screening decision making. Reference lists from relevant articles were also reviewed. Finally, published abstracts and subsequent full papers from annual meetings of the Society
Literature Search
The MEDLINE search yielded 357 articles. After reviewing these articles and their reference lists, 20 articles that reported evaluations of prostate cancer screening decision aids were identified. One additional study was found in the published abstracts of the SMDM and a second in the reference list from Evans et al.12 Of these 22 articles, four were excluded: one lacked a control group,19 one focused on treatment decision making,20 one because it was unclear whether a decision aid had been
Discussion
This review updates two previous reviews, one of patient decision aids in general10 and a second limited to aids for prostate cancer screening.12 Eight evaluations of prostate cancer screening decision aids had been published since Evans et al.12 conducted their review, including two community-based trials. This review confirms the findings from broader reviews of decision aids, while highlighting some of the issues unique to prostate cancer screening. As with aids in general,10 prostate cancer
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