A Computer-Tailored Decision Aid to Promote Informed Decision-Making for Prostate Cancer Screening Jennifer D. Allen. Deborah Bowen, Gary Bennett, Alton Hart, Christopher Lathan, Yi Li Harvard School of Public health Boston University University of Washington Working the Network: The Network is Working!

Background & Rationale Most frequently diagnosed (non-skin) cancer Second leading cause of cancer deaths Established risk factors are non-modifiable No data from RCT to demonstrate ↓ of disease-specific mortality Informed decision-making recommended

Connecting Investigators

‘Take the Wheel’ Trial Specific aims: 1.Develop & test efficacy of interactive DA for employed men age Assess intervention dose & reach Hypotheses: Men in Ix worksites will: 1.Be more likely to have made a decision (Stage of Decision Making); 2.Have higher levels of IDM as evidenced by:  ↑ Knowledge  ↑ Decision Self Efficacy  ↑ Consistency between decision & individual values

Baseline Assessments (12 worksites) Intervention Group (n=6 worksites) Comparison Group (n=6 worksites) Final Assessments (12 worksites) randomization Formative Research & Recruitment of Worksites Study Design

Methods Manufacturing worksites recruited (N=12) Random sampling from employee rosters Eligibility criteria Age 45+ Permanent employee, > 20 hrs/week Self-administered surveys on work-time

Decision Aid Intervention Primary Outcomes: IDM  Knowledge  Decision Self-Efficacy  Consistency between Values & Decision Secondary Outcomes  Satisfaction  Decisional conflict Conceptual Framework Targets for Intervention (Mediators) Awareness of CaP & understanding of risks, benefits, limitations of screening Risk perceptions Evaluations of pros/cons (Values Clarification) Role modeling of SDM Individual Characteristics (Modifiers)  Demographics  Health status  Screening history  Family history Values Based on tenets from Ottawa Decision Support Framework, Health Belief Model, Social Cognitive Theory Stage of Decision Making Call for Conceptual Clarity Review of Theoretical Frameworks

ID NUMBER Instructions Welcome What the experts say Age Ca Diagnosis Height Animal Fat Tomatoes Family History Race LEARN MORE What is CaP? What is screening? What are risk factors? What happens after screening? What are the treatments for CaP? What’s my risk? Step 1: What are your options ? Step 2: How do you make decisions? Step 4: What’s important to you ? Choose Pros Choose Cons Prioritize Pros Prioritize Cons Above average risk Average risk Below Average Risk Step 3: What do you need to know? Step 5: What are you leaning towards? DECIDE Decisional Balance Your Next Steps PRINTOUT Flowchart of Decisional Aid Corresponds to Survey question Interactive screen Feedback screen (Tailored)

IDM Components Source of MeasureSample ItemScoring Stage of Decision Making O’Connor, Jacobsen & Stacey, 2000 “At this time, would you say you… Have already made a decision… 1 Item Not Scored Knowledge Radosevich et al 2004“The PSA will find all cancers” 14 true/false items Score: proportion of correct responses Range: 0-100% Decision Self-Efficacy O’Connor 1995“I feel confident that I can figure out the best option for me, personally” 11 items; 3 response categories Raw score: 0-44 Converted score: 0-100% Consistency between Values & Decision Developed“If getting treated for CaP meant I might not be able to control my urine, I might choose not to get tested” + prefers not to get screened 8 items; 5 response categories Values range: -16 to +16 “Consistent” (y/n)= +/y or -/n Measures Measures Review

Baseline Characteristics, Cohort (n=828) CharacteristicsPercent Age > Race/ethnicity White, non-Hispanic91 Income <$50K $50-74K >$75K Education < HS Some – 4yr college > 4-year college Ever heard of PSA (Ever had a PSA) Ever heard of DRE (Ever had a DRE) Mean RR 71%

Components of Informed Decision Making, Baseline IDM componentTotal (n=828) Decided (n=285; 35%) Undecided (n=511; 63%) Stage of Decision Making % Decided 36% Knowledge (0-100%) Decision self-efficacy (0-100%) Decisional consistency Values (mean= Composite Measure of IDM? Interpretation

Future Plans DA tool for African American men (R01 Pending) Dissemination research… ACS Service Employees International Union Go forth & disseminate!