Decision counseling for men considering prostate cancer screening

Abstract

One in six men will develop prostate cancer in their lifetimes; and the risk of dying from the disease is elevated by a factor of at least two among African-American men. Many asymptomatic men who are diagnosed with prostate cancer have their disease detected through a prostate cancer screening examination. The examination often includes both a digital rectal examination and prostate-specific antigen testing. Although annual screening is recommended by several organizations, others urge caution since no randomized trials have demonstrated that screening can reduce mortality from prostate cancer. Concern about prostate cancer screening is also based on the fact that diagnosis and treatment of early-stage prostate cancer can cause substantial adverse outcomes. To facilitate shared decision making between the patient and medical practitioner, it is important to provide information that is needed to make an informed decision. In this paper, we discuss the development and implementation of a decision-counseling protocol for prostate cancer screening. This protocol, which incorporates the analytic hierarchy process (AHP), is designed as a decision aid for use in facilitating decision making about whether or not to have a screening examination. We discuss several modifications to the standard AHP that were required to fit the needs of the target population. The counseling protocol has been applied in randomized trials involving diverse populations. While health educators required some training to administer the decision-counseling protocol, none was needed for the patients. The results have demonstrated that a well-designed decision-counseling protocol administered by a trained facilitator can be successfully implemented in a primary care patient population. Scope and purpose In this paper, we discuss the development and implementation of a decision- counseling protocol for prostate cancer screening. The protocol was developed by a multidisciplinary research team of which the authors are members. It consists of two components: an information booklet on prostate cancer and screening; and an AHP-based counseling session. Modifications to the standard AHP that were required to fit the needs of the target population are described. This decision-counseling protocol was successfully applied in four primary care settings, with preliminary findings reported for one of these.