Promoting Prostate-Specific Antigen Informed Decision-Making: Evaluating Two Community-Level Interventions
Background
Most medical associations recommend that patients make informed decisions about whether to be screened for prostate cancer with the prostate-specific antigen (PSA) test. Studies assessing how to promote PSA informed decision-making (IDM) have been conducted almost exclusively in healthcare settings; there is a need for similar research in community settings.
Methods
This paper describes the results of a 5-year study (2002–2007) in which two community-level interventions were developed, implemented, and evaluated in matched upper- and lower-SES comparison communities in Greensboro and Wilmington, North Carolina. Both interventions promoted PSA informed decision-making. One intervention (PSA-Only) consisted of educational information about prostate cancer and the PSA test, and the other (Men's Health) included additional information about recognizing and preventing heart attack, stroke, and colon cancer. Structured survey, semistructured interview, and structured observational data were combined to compare participating community residents' pre/post changes in knowledge, intentions, and behaviors related to PSA IDM.
Results
The community-level interventions successfully engaged community participants in discussions, educated individuals, encouraged deliberation of information, and facilitated PSA test discussions with physicians. Men who participated in the PSA-Only educational sessions were more likely than those who attended the Men's Health educational sessions to discuss the PSA test with their physician (p=0.037).
Conclusions
When prospective SES-related confounding factors are matched across comparison communities, PSA IDM interventions can be shown to promote IDM. Framing the PSA test decision relative to less-ambiguous screening decisions does not appear to increase the likelihood of PSA IDM.
aRTI International, Research Triangle Park, North Carolina
bCecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Address correspondence and reprint requests to: David Driscoll, PhD, MPH, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park NC 27709.
ABSTRACT