Table 1.
The intervention structure and content
| Intervention component | Purpose | Content |
|---|---|---|
| Video for Patients |
1) To describe key messages about prostate cancer screening |
1) Key messages: |
| · There are two kinds of prostate cancer—harmless and dangerous | ||
| · A problem with the PSA test is that it leads some men with a harmless prostate cancer to get treatment that they do not need. | ||
| · About half of all men who get treatment for prostate cancer will have permanent side effects | ||
| · Men should decide whether the PSA test is right for them and talk with their doctor. | ||
| 2) To model the process of learning and deciding about prostate cancer screening |
2) Modeling: |
|
| · 4 men engage in an after-hours discussion with their physician | ||
| · Each man participates in questioning and reasoning about screening | ||
| 3) To facilitate values clarification via a process of social matching with two men making opposite decisions using the same facts |
Values Clarification: |
|
| · Joe decides to get the PSA test after considering the facts | ||
| · Frank decides NOT to get the PSA test after considering the facts | ||
| Coaching Session for Patients |
1) To answer men’s questions about prostate cancer screening by providing a supplemental educational brochure |
1) Key facts: |
| · Location of the prostate | ||
| · Characteristics of the PSA test | ||
| · Characteristics of prostate cancer | ||
| · Risk factors for prostate cancer | ||
| · Treatment options and their side effects | ||
| 2) To help men clarify their values for screening by ranking and rating decisional attributes |
2) Decisional Attributes: |
|
| · Magnitude of the problem (e.g. prostate cancer) | ||
| · Benefit in knowing one has prostate cancer | ||
| · The (un)certainty of the PSA test | ||
| · The (un)certainty of treatment outcomes | ||
| · Worry about treatment side effects | ||
| 3) To help men prepare for a discussion with their doctor by delivering tailored messages about discussion barriers and by providing a pad on which to write their screening decision and any questions for their doctor |
2) Barriers to Discussion: |
|
| · Discomfort asking questions | ||
| · Fear of expressing opinions | ||
| · Difficulty interrupting the doctor | ||
| · Difficulty disagreeing with the doctor | ||
| · Worry about taking too much of the doctor’s time | ||
| · Difficulty understanding medical jargon | ||
| · Embarrassment asking questions | ||
| Education Session for Providers | 1) To review the evidence for prostate cancer screening |
1) Evidence: |
| · Natural History of prostate cancer | ||
| · Lack of clear benefit of prostate cancer screening | ||
| · Certain harms of screening and early treatment | ||
| 2) To highlight the value of shared decision making for prostate cancer screening | 2) Value of Shared Decision Making: |
|
| · Ethical obligation to consider patient preferences in the face of uncertain outcomes |