Landrey Alison R, Matlock Daniel D, Andrews Laura, Bronsert Michael, Denberg Tom
Department of General Internal Medicine, University of Colorado, Denver, CO, USA.
J Prim Care Community Health. 2013 Jan;4(1):67-74. doi: 10.1177/2150131912447074. Epub 2012 May 16.
Professional societies recommend that the decision to screen for prostate cancer involves a shared discussion between patient and provider. Many men are tested without this discussion. Prostate cancer screening decision aids increase patient knowledge and participation in prostate-specific antigen (PSA) testing decisions under ideal circumstances but are often resource intensive and elaborate. There is a need for evaluation of interventions that are low cost, low literacy, and practical for widespread distribution. The authors evaluated the effect of a mailed low-literacy informational patient flyer about the PSA test on measures of shared decision making.
A pragmatic randomized controlled trial comparing the mailed flyer versus usual care was conducted among 303 men aged 50 to 74 years who were scheduled for annual health maintenance exams in 2 general internal medicine clinics (University of Colorado and University of Colorado Hospital). Charts were reviewed after the visits for documentation of PSA screening discussions and PSA testing rates. Follow-up patient surveys assessed include perceived participation in PSA screening decisions, knowledge of the PSA test, and flyer acceptability.
Rates of chart-documented PSA discussions were low with no difference between the flyer and control groups (17.7% and 13.6%, respectively; P = .28). Rates of PSA testing were also similar in both groups (62.5% vs 58.5%; P = .48). Rates of patient-reported PSA discussions were higher than the documented rates but also without differences between the groups (71.8% vs 62.3%; P = .22). The intervention had no effect in the PSA knowledge scores (3.5/5 vs 3.3/5, P = .60). Patients found the flyer to be highly acceptable.
A mailed low-literacy informational flyer was well received by patients but had no effect on rates of PSA discussions, PSA testing, or patient knowledge of prostate cancer screening.
专业协会建议，前列腺癌筛查的决策应在患者与医疗服务提供者之间进行共同讨论。许多男性在未进行这种讨论的情况下就接受了检测。前列腺癌筛查决策辅助工具在理想情况下可增加患者的知识并提高其参与前列腺特异性抗原（PSA）检测决策的程度，但通常资源消耗大且复杂。需要评估那些低成本、低文化要求且便于广泛分发的干预措施。作者评估了一份邮寄给患者的低文化水平PSA检测信息传单对共同决策措施的影响。
在两家普通内科诊所（科罗拉多大学和科罗拉多大学医院）中，对303名年龄在50至74岁、计划进行年度健康体检的男性进行了一项实用的随机对照试验，比较邮寄传单与常规护理。就诊后查阅病历，记录PSA筛查讨论情况和PSA检测率。后续的患者调查评估包括对PSA筛查决策的感知参与度、对PSA检测的了解程度以及传单的可接受性。
病历记录的PSA讨论率较低，传单组和对照组之间无差异（分别为17.7%和13.6%；P = 0.28）。两组的PSA检测率也相似（62.5%对58.5%；P = 0.48）。患者报告的PSA讨论率高于记录的比率，但两组之间也无差异（71.8%对62.3%；P = 0.22）。该干预措施对PSA知识得分没有影响（3.5/5对3.3/5，P = 0.60）。患者认为传单非常可接受。
邮寄的低文化水平信息传单受到患者的好评，但对PSA讨论率、PSA检测率或患者对前列腺癌筛查的了解程度没有影响。
