COMMENTARY

Prostate Cancer Screening Decision Aids Are No Substitute for Patient-Doctor Discussion

Gerald Chodak, MD

Disclosures

September 09, 2019

This transcript has been edited for clarity.

I'm Dr Gerald Chodak for Medscape, speaking about the potential value of decision aids to help men decide whether they should be screened for prostate cancer.

Prostate cancer screening remains controversial, and current guidelines recommend a shared decision-making process in which men are informed about the risks and benefits before screening takes place. How often that occurs is unclear, but decision aids may help in that process.

Riikonen and colleagues[1] have performed a meta-analysis of studies on prostate cancer screening decision aids published from 1999 to 2017. They found 19 randomized studies involving almost 13,000 men. Usual care consisted of no formal structured presentation. An intervention was classified as a decision aid if it contained information about the risk of dying from prostate cancer, and the potential urinary, bowel, and sexual complications that can occur with treatment. Decision aids that were used included printed material, group or individual education sessions, computer-based tools, or videos.

The authors evaluated five outcomes: knowledge about prostate cancer screening, decisional conflict, whether discussions regarding screening took place between men and their physicians, whether screening transpired, and satisfaction with the screening decision. They used the International Patient Decision Aids Standards, which include 10 different criteria, to evaluate the various studies to determine whether a study was high, moderate, low, or very low quality.

The findings were somewhat disappointing. The authors found no difference in men's decisions to undergo or not undergo prostate cancer screening between those who used a decision aid and those who did not. They also found no strong evidence that the use of a decision aid results in physicians and patients discussing prostate cancer screening, or improves a man's ability to decide whether to undergo or not undergo screening.

The bottom line is that decision aids by themselves will not compensate for the necessary interactions between physician and patient. Decision aids do not help save time for physicians and enable them to avoid having a formal conversation about the risks and benefits of prostate cancer screening.

We need more new studies that take some of these considerations into account. Part of the problem with this analysis is that some of the decision aid studies that were included were done before the results of major screening trials had been published. Thus, there was some misinformation about what screening could offer. Still, we know that there are pros and cons to screening, and in order for a man to make an informed decision, he needs to have a conversation with his physician. How best to facilitate that remains unclear.

I look forward to your comments. Thank you.

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