Cancer Control Research5R21CA108666-02
Costanza, Mary E.
A NOVEL DECISION AID FOR PROSTATE CANCER SCREENING
DESCRIPTION (provided by applicant): The goal of this R21 proposal is to develop, pilot test and evaluate a novel decision aid for prostate cancer screening that combines a computer assisted telephone counseling service with print materials to be used as a primary care provider (PCP) referral service to help men make an informed decision about whether to get Prostate Specific Antigen (PSA) testing. The decision aid will give men basic information about PSA, make them aware of the screening controversy, review the pros and cons of PSA testing and provide them with a values clarification exercise. The counseling will be tailored to the individual's stage of readiness to make an informed decision. The computer script and print materials used in this project will be suitable for use with men with marginal literacy and will be culturally appropriate for use with African-Americans (a subgroup at higher than average risk for prostate cancer). Stage-based counseling is a novel approach for decision aids. PSA testing is well suited for testing the effectiveness of this approach due to the controversy among professionals about its effectiveness in reducing mortality from prostate cancer and because of the risks of untoward side effects from aggressive treatment. To date, no decision aid for PSA testing has combined print materials, telephone counseling and a referral model. This combined approach is: 1) less expensive than on-site counselors, 2) provides live conversations, and 3) permits PCPs to leverage their time with patients by shifting the burden of basic education and values clarification to a credible referral service. Phase 1 includes focus groups and key informant interviews to inform intervention content that includes an existing award winning pamphlet (PROCASE), the development of new print and graphic materials and a new computerized counseling script. Phase 2 will pilot test 1) a letter from the PCP recommending the referral service and intervention print materials, 2) a counseling call and 3) a follow-up letter to the subject and his referring PCP. Outcomes are: effectiveness of the counseling service; acceptability of the intervention and feasibility of the counseling service. If successful, this decision aid can be tested in a randomized controlled trial against other standard decision aids.