The broad, long-term goal of this project is to foster shared decision-making by men, their spouses, and their physicians regarding the early detection of prostate cancer. The investigators propose a primary care-based, randomized, controlled trial of a tailored detection aid for prostate cancer screening. A computerized, interactive decision tool, named the Computerized Decision Support System (CDSS), for prostate cancer screening, will be developed for this study and will emphasize personal values in the decision-making process. The CDSS tools will be tailored not only for high-risk patients (particularly African American men), but will also be developed for use with low literacy patients, and for Spanish-speaking patients. A novel aspect of this study is the two strategies to be used for delivering the intervention. In strategy A, male primary care patients who are appropriate screening candidates will be randomly allocated to receive the CDSS tool or to be part of a control group (to include couples in which the husband is the target); in strategy B, female patients whose husbands are appropriate screening candidates will be randomly allocated to receive the CDSS tool or to be part of a control group (to include couples in which the wife is the target). The sample will include 300 couples from each of the three dominant ethnic groups (white, African American, and Mexican American) for a total of 900 couples served by the Harris County Hospital District in Houston, Texas.
The specific aims of this study are as follows: (1) to develop a computerized, tailored, interactive tool (CDSS) to promote informed decision-making for prostate cancer screening by couples of different ethnic backgrounds; (2) to adapt current measures of decision-making processes and outcomes for use with Spanish-speaking and low literacy patients, in preparation for evaluating the CDSS, and (3) to conduct a randomized, controlled, trial of the CDSS, when implemented in community-based primary care settings with patients of different ethnic backgrounds. Outcomes will include: screening behavior; interest in prostate cancer screening; decisional conflict; satisfaction with the screening decision, satisfaction with the decision-making process; patient-physician communication about screening; and patient knowledge about prostate cancer. The primary outcome, screening behavior, will be tracked over a six-month follow-up period by using self-report interviews and medical chart reviews. These outcome analyses will be complemented by a qualitative study of the dynamics of intra-couple communication, following exposure of either husband or wife to the CDSS tool, in 30 couples (10 couples from each of the three ethnic groups). It is expected that the findings from this study will suggest appropriate modes for administering shared decision-making tools in community-based, primary care settings.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Meyers, David
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Baylor College of Medicine
Family Medicine
Schools of Medicine
United States
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Linder, Suzanne K; Swank, Paul R; Vernon, Sally W et al. (2012) Is a prostate cancer screening anxiety measure invariant across two different samples of age-appropriate men? BMC Med Inform Decis Mak 12:52
Linder, Suzanne K; Swank, Paul R; Vernon, Sally W et al. (2011) Validity of a low literacy version of the Decisional Conflict Scale. Patient Educ Couns 85:521-4
Linder, Suzanne K; Hawley, Sarah T; Cooper, Crystale P et al. (2009) Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey. BMC Fam Pract 10:19
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