Pairing physician education with patient activation to improve shared decisions in prostate cancer screening: A cluster randomized controlled trial

Michael S Wilkes, Frank C. Day, Malathi Srinivasan, Erin Griffin, Daniel J Tancredi, Julie A. Rainwater, Richard L Kravitz, Douglas S. Bell, Jerome R. Hoffman

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. Methods Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Webbased educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening. Results Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control = 38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A = 50%, MD-Ed = 33%, control = 15%; P <.05). Of the male patients, 80% had had previous PSA tests. Conclusions Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.

Original languageEnglish (US)
Pages (from-to)324-334
Number of pages11
JournalAnnals of Family Medicine
Volume11
Issue number4
DOIs
StatePublished - Jul 2013

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Patient Participation
Patient Education
Early Detection of Cancer
Prostatic Neoplasms
Randomized Controlled Trials
Physicians
Decision Making
Primary Care Physicians
Prostate-Specific Antigen
Education
Group Practice
Pamphlets
Centers for Disease Control and Prevention (U.S.)

Keywords

  • Decision making
  • Doctor-patient communication
  • Medical uncertainty
  • Patient activation
  • Patient-centered care
  • Patient-physician relationship
  • Prostate
  • Randomized controlled trial
  • Shared
  • Standardized patient

ASJC Scopus subject areas

  • Family Practice

Cite this

Pairing physician education with patient activation to improve shared decisions in prostate cancer screening : A cluster randomized controlled trial. / Wilkes, Michael S; Day, Frank C.; Srinivasan, Malathi; Griffin, Erin; Tancredi, Daniel J; Rainwater, Julie A.; Kravitz, Richard L; Bell, Douglas S.; Hoffman, Jerome R.

In: Annals of Family Medicine, Vol. 11, No. 4, 07.2013, p. 324-334.

Research output: Contribution to journalArticle

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title = "Pairing physician education with patient activation to improve shared decisions in prostate cancer screening: A cluster randomized controlled trial",
abstract = "Background Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. Methods Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Webbased educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening. Results Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65{\%}, MD-Ed = 41{\%}, control = 38{\%}; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A = 50{\%}, MD-Ed = 33{\%}, control = 15{\%}; P <.05). Of the male patients, 80{\%} had had previous PSA tests. Conclusions Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.",
keywords = "Decision making, Doctor-patient communication, Medical uncertainty, Patient activation, Patient-centered care, Patient-physician relationship, Prostate, Randomized controlled trial, Shared, Standardized patient",
author = "Wilkes, {Michael S} and Day, {Frank C.} and Malathi Srinivasan and Erin Griffin and Tancredi, {Daniel J} and Rainwater, {Julie A.} and Kravitz, {Richard L} and Bell, {Douglas S.} and Hoffman, {Jerome R.}",
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AU - Griffin, Erin

AU - Tancredi, Daniel J

AU - Rainwater, Julie A.

AU - Kravitz, Richard L

AU - Bell, Douglas S.

AU - Hoffman, Jerome R.

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N2 - Background Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. Methods Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Webbased educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening. Results Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control = 38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A = 50%, MD-Ed = 33%, control = 15%; P <.05). Of the male patients, 80% had had previous PSA tests. Conclusions Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.

AB - Background Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician's final recommendations. Methods Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Webbased educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients' reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients' reported shared decision making and the physician's recommendation for prostate cancer screening. Results Patients' ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control = 38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A = 50%, MD-Ed = 33%, control = 15%; P <.05). Of the male patients, 80% had had previous PSA tests. Conclusions Although activating physicians and patients did not lead to significant changes in all aspects of physician attitudes and behaviors that we studied, interventions that involved physicians did have a large effect on their attitudes toward screening and in the discussions they had with patients, including their being more likely than control physicians to engage in prostate cancer screening discussions and more likely to be neutral in their final recommendations.

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KW - Standardized patient

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