A Computer-Tailored Decision Aid to A Computer-Tailored Decision Aid to Promote Informed Decision-Making for Promote Informed Decision-Making for

Prostate Cancer ScreeningProstate Cancer Screening

Jennifer D. Allen. Deborah Bowen, Gary Bennett, Alton Hart, Christopher Lathan, Yi Li

Harvard School of Public healthBoston University

University of Washington

Working the

Network: The

Network is

Working!

Background & RationaleBackground & Rationale

• Most frequently diagnosed (non-skin) cancer• Second leading cause of cancer deaths • Established risk factors are non-modifiable• No data from RCT to demonstrate ↓ of

disease-specific mortality • Informed decision-making recommended

Connecting

Investigators

‘‘Take the Wheel’ TrialTake the Wheel’ Trial

• Specific aims:1. Develop & test efficacy of interactive DA for employed men age 45+

2. Assess intervention dose & reach

• Hypotheses:Men in Ix worksites will:

1. Be more likely to have made a decision (Stage of Decision Making);

2. Have higher levels of IDM as evidenced by: ↑ Knowledge ↑ Decision Self Efficacy ↑ Consistency between decision & individual values

Baseline Assessments(12 worksites)

Intervention Group(n=6 worksites)

Comparison Group(n=6 worksites)

Final Assessments(12 worksites)

randomization

Formative Research & Recruitment of Worksites

Study DesignStudy Design

MethodsMethods

• Manufacturing worksites recruited (N=12)• Random sampling from employee rosters • Eligibility criteria

• Age 45+• Permanent employee, > 20 hrs/week

• Self-administered surveys on work-time

Decision Aid Intervention

Primary Outcomes: IDM

Knowledge Decision Self-

Efficacy Consistency

between Values & Decision

Secondary Outcomes Satisfaction Decisional conflict

Conceptual Framework

Targets for Intervention(Mediators)

• Awareness of CaP & understanding of risks, benefits, limitations of screening

• Risk perceptions• Evaluations of

pros/cons (Values Clarification)

• Role modeling of SDM

IndividualCharacteristics

(Modifiers) Demographics Health status Screening history Family history• Values

Based on tenets from Ottawa Decision Support Framework, Health Belief Model, Social Cognitive Theory

Stage of Decision Making

C

all for

Conceptual C

larity Review of

Theoretical

Frameworks

ID NUMBER

InstructionsWelcomeWhat the experts say

AgeCa DiagnosisHeightAnimal FatTomatoesFamily HistoryRace

LEARN MOREWhat is CaP?What is screening?What are risk factors?What happens after screening?What are the treatments for CaP?What’s my risk?

Step 1: What are

your options?

Step 2: How do you make decisions?

Step 4: What’s

important to you?Choose ProsChoose Cons

Prioritize ProsPrioritize Cons

Above average riskAverage riskBelow Average Risk

Step 3: What do you need to know?

Step 5: What are you leaning towards?

DECIDE

Decisional Balance

Your Next Steps

PRINTOUT

Flowchart of Decisional Aid

Corresponds to Survey question

Interactive screen

Feedback screen (Tailored)

IDM Components Source of Measure Sample Item Scoring

Stage of Decision Making

O’Connor, Jacobsen & Stacey, 2000

“At this time, would you say you…Have already made a decision…

1 ItemNot Scored

Knowledge Radosevich et al 2004 “The PSA will find all cancers”

14 true/false itemsScore: proportion of correct responsesRange: 0-100%

Decision Self-Efficacy O’Connor 1995 “I feel confident that I can figure out the best option for me, personally”

11 items; 3 response categories Raw score: 0-44Converted score: 0-100%

Consistency between Values & Decision

Developed “If getting treated for CaP meant I might not be able to control my urine, I might choose not to get tested” + prefers not to get screened

8 items; 5 response categoriesValues range: -16 to +16“Consistent” (y/n)= +/y or -/n

MeasuresMeasures Measures Review

Baseline Characteristics, Cohort (n=828)Baseline Characteristics, Cohort (n=828)Characteristics Percent

Age 45-49 50-59 > 60

3350

9

Race/ethnicity White, non-Hispanic 91

Income <$50K $50-74K >$75K+

152454

Education < HS Some – 4yr college > 4-year college

245618

Ever heard of PSA(Ever had a PSA)

6667

Ever heard of DRE(Ever had a DRE)

9291

Mean RR 71%

Components of Informed Components of Informed Decision Making, Baseline Decision Making, Baseline

IDM component Total(n=828)

Decided(n=285; 35%)

Undecided(n=511; 63%)

Stage of Decision Making% Decided

36%

Knowledge(0-100%)

56 65 51

Decision self-efficacy(0-100%)

78 87 73

Decisional consistencyValues (mean= 8

81 94 74

Composite

Measure

of IDM?

Interpretation

Future Plans

• DA tool for African American men (R01 Pending)

• Dissemination research…• ACS• Service Employees International Union

Go forth & disseminate!