Comparing 3 techniques for eliciting patient values for decision making about prostate-specific antigen screening: a randomized controlled trial.

IMPORTANCE: To make good decisions about prostate-specific antigen (PSA) screening, men must consider how they value the different potential outcomes. OBJECTIVE: To determine the effects of different methods of helping men consider such values. DESIGN AND SETTING: Randomized trial from October 12 to 27, 2011, in the general community. PARTICIPANTS: A total of 911 men aged 50 to 70 years from the United States and Australia who had average risk. Participants were drawn from online panels from a survey research firm in each country and were randomized by the survey firm to 1 of 3 values clarification methods: a balance sheet (n = 302), a rating and ranking task (n = 307), or a discrete choice experiment (n = 302). INTERVENTION: Participants underwent a values clarification task and then chose the most important attribute. MAIN OUTCOME MEASURES: The main outcome was the difference among groups in the most important attribute. Secondary outcomes were differences in unlabeled test preference and intent to undergo screening with PSA. RESULTS: The mean age was 59.8 years; most participants were white and more than one-third had graduated from college. More than 40% reported a PSA test within 12 months. The participants who received the rating and ranking task were more likely to report reducing the chance of death from prostate cancer as being most important (54.4%) compared with those who received the balance sheet (35.1%) or the discrete choice experiment (32.5%) (P < .001). Those receiving the balance sheet were more likely (43.7%) to prefer the unlabeled PSA-like option (as opposed to the "no screening"-like option) compared with those who received rating and ranking (34.2%) or the discrete choice experiment (20.2%). However, the proportion who intended to undergo PSA testing was high and did not differ between groups (balance sheet, 77.1%; rating and ranking, 76.8%; and discrete choice experiment, 73.5%; P = .73). CONCLUSIONS AND RELEVANCE: Different values clarification methods produce different patterns of attribute importance and different preferences for screening when presented with an unlabeled choice. Further studies with more distal outcome measures are needed to determine the best method of values clarification, if any, for decisions such as whether to undergo screening with PSA.

Duke Scholars

Author Michael Patrick Pignone Medicine, General Internal Medicine