Informed Decision-Making for Prostate Cancer Screening: A Prospective, Randomized Study of 2 Novel Web-Based, Electronic Visits.
Joseph Presti, Stephanie Prausnitz, Andrea Altschuler et al.
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In 30 seconds
This randomized quality improvement study compared two web-based electronic visits for prostate cancer screening decisions among 3,200 screen-eligible men in Kaiser Permanente Northern California, equally representing four self-reported race/ethnicity categories. One visit provided general information; the other added a personalized estimate of elevated PSA risk based on age and race. Overall completion was similar between formats (16.2% informational vs 14.7% interactive; P = .24). Among men who completed a visit, the interactive format was associated with more screening decisions and PSA test requests.
Key findings
- Overall E-visit completion was 15.6%; rates were 16.2% for informational and 14.7% for interactive visits (P = .24).
- Completion was higher among White than Black men (18.5% vs 13.1%, P = .02) and among men aged 60 to 69 versus 50 to 59 years (18.8% vs 15.4%, P = .045).
- Among completers, screening decisions were more frequent with the interactive than informational visit (98.7% vs 91.2%, P < .001).
- Among completers, PSA test requests were more frequent with the interactive than informational visit (96.2% vs 90.0%, P = .008).
Why it matters
The findings distinguish engagement from decision support: adding personalized risk information did not increase the proportion completing an E-visit, but among those who completed it, more made a screening decision and requested PSA testing. Differences in completion by age and race also indicate that the reach of digital decision tools may vary across patient groups.
What to keep in mind
Only 15.6% of men completed an E-visit, so outcomes among completers may not represent all men offered the tools.