Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1034 — Who Uses Decision Aids? Findings from a Trial Comparing Two Prostate Cancer Screening Decision Aids

Author List:
Partin MR (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Nelson D (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Flood AB (Center for the Evaluative Clinical Sciences, Dartmouth Medical School)
Friedemann-Sanchez G (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Wilt TJ (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)

Objectives:
This study examined who used unsolicited prostate cancer screening decision aids distributed as part of a randomized controlled trial and how selective utilization affected knowledge of the risks and benefits of prostate cancer screening.

Methods:
1152 veterans age 50 and older from one of four VA facilities in the Midwest were randomly assigned to: mailed pamphlet, mailed video, or usual care (control). Materials were mailed two weeks prior to scheduled primary care appointments and outcomes assessed by telephone survey one week after appointments. Analyses examined use of materials by study group, the association of use (by type of material offered) with patient characteristics, and the effect of material use (before and after adjusting for patient characteristics) on scores for a previously validated, ten-item prostate cancer screening knowledge index.

Results:
56% of video and 50% of pamphlet subjects reported using the materials. Pamphlet use did not vary by patient characteristics. Video use was higher for patients with greater than a high school education, married patients, and patients reporting no prior abnormal prostate cancer screening test results. In intent-to-treat analyses, individuals randomized to both the video and pamphlet groups had significantly higher knowledge scores relative to the control group (7.44, 7.26 and 6.90, respectively). After combining subjects randomized to the video and pamphlet groups who reported not using the materials with control subjects, the knowledge scores were 7.74 for the using video group, 7.52 for the using pamphlet group, and 6.83 for the combined non-user/control group. Adjusting for the selectivity of utilization by patient characteristics produced scores of 7.75 for the using video group, 7.45 for the using pamphlet group and 6.97 for the combined non-user/control group.

Implications:
Overall utilization of the unsolicited educational materials was low, and selectivity of utilization varied by type of aid. Because the overall effects of both aids on knowledge were modest, adjusting for utilization did not markedly alter conclusions about their effects on this outcome.

Impacts:
Efforts to broadly implement prostate cancer screening decision aids may need to offer a variety of approaches, and incorporate creative strategies to enhance utilization, in order to reach all population subgroups.