Tran Viet-Thi, Kisseleva-Romanova Elena, Rigal Laurent, Falcoff Hector
Department of General Medicine, Paris Diderot University, Paris, France.
Department of General Medicine, Paris Descartes University, Paris, France.
Br J Gen Pract. 2015 May;65(634):e295-304. doi: 10.3399/bjgp15X684817.
Despite recommendations against systematic screening for prostate cancer, 70% of patients still request prostate-specific antigen testing.
To assess the impact of a decision aid on patients' intention to undergo prostate cancer screening.
Randomised controlled trial with two-arm parallel groups in 86 general practices in urban and rural areas in France.
Males aged 50-75 years were randomised to receive either the decision aid (intervention group) or usual care (control group). The primary outcome was the proportion of patients' intending to undergo prostate cancer screening, assessed immediately after reading the decision aid. The reasons underlying their choice were elicited and the proportion of patients citing each reason to undergo, or not undergo, prostate cancer screening were compared between the two arms.
A total of 1170 patients were randomised (588 in the intervention arm) from November 2012 to February 2013. The proportion of patients who intended to be tested for prostate cancer in the intervention arm (123 patients [20.9%]) was significantly reduced compared with the control arm (57 patients [9.8%]) (difference 11.1%, 95% confidence interval [CI] = 7.0 to 15.2, P<0.0001). In the intervention group, a lower proportion of individuals expressed that cancer screening would protect them from the disease, compared with the control group (P<0.0001), while a greater proportion of individuals stated that prostate cancer screening would not benefit their health (P<0.0001) and may involve procedures with harmful side effects (P = 0.0005).
The decision aid improved participants' informed decision making and reduced their intent to undergo prostate cancer screening.
尽管有不建议进行前列腺癌系统筛查的相关建议，但仍有70%的患者要求进行前列腺特异性抗原检测。
评估决策辅助工具对患者进行前列腺癌筛查意愿的影响。
在法国城乡地区的86家全科诊所进行的双臂平行随机对照试验。
将年龄在50 - 75岁的男性随机分为接受决策辅助工具组（干预组）或常规护理组（对照组）。主要结局是患者打算进行前列腺癌筛查的比例，在阅读决策辅助工具后立即进行评估。引出他们选择的原因，并比较两组中提及每种进行或不进行前列腺癌筛查原因的患者比例。
2012年11月至2013年2月，共有1170名患者被随机分组（干预组588名）。干预组中打算进行前列腺癌检测的患者比例（123例[20.9%]）与对照组（57例[9.8%]）相比显著降低（差异11.1%，95%置信区间[CI]=7.0至15.2，P<0.0001）。在干预组中，与对照组相比，表达癌症筛查能使他们免受疾病侵害的个体比例更低（P<0.0001），而更多个体表示前列腺癌筛查对其健康无益处（P<0.0001）且可能涉及有有害副作用的检查（P = 0.0005）。
决策辅助工具改善了参与者的知情决策，并降低了他们进行前列腺癌筛查的意愿。
