Providing quality health information through decision aids (under different formats such as websites, apps, videos or brochures) significantly increases patient awareness, reduces indecision, and fosters an active role for men who have to decide on taking a PSA test – an analysis that can identify prostate cancer, but which presents several risks, such as overdiagnosis and adverse effects of overtreatment such as erectile dysfunction and urinary incontinence.
These are the results of a large study carried out by researchers from CINTESIS – Center for Health Technology and Services Research. The researchers did a statistical synthesis of the most important studies carried out on this topic. The paper was published in the Journal of Medical Internet Research, a leading scientific journal in the field of Medical Informatics and one of the most important journals on Research in Health Services.
There are health situations that make decisions difficult to take. “In some cases the likelihood of medical intervention causing harm, is similar, and even greater, than the probability of causing benefit. In these situations, and for the patient to take an informed decision, he should be encouraged to take part in the decision-making process,” explains Carlos Martins, the CINTESIS researcher coordinating this research.
“Decision aids” are tools based on scientific evidence and designed to support the patients’ decision-making process with regard to their health. They can be implemented in different formats (Internet, paper, video).
During this shared medical decision process, the patient understands the risk and severity of the disease to be prevented and is informed of the risks, benefits, alternatives and uncertainties of the test, and should weigh these data in the light of his personal values.
Prostate cancer screening through PSA, aimed at asymptomatic and risk-free men, is one of the situations in which the shared decision is recommended, since it has advantages (decrease of mortality, gain in years of life), but also risks (diagnosis of cancers that may be innocuous, treatment related risk such as erectile dysfunction or urinary incontinence).
This systematic review and meta-analysis aimed to compare the impact of Internet-based decision-aids with other formats to support the prostate cancer screening decision. “The results have shown that decision-aids on the Internet improve knowledge about screening for prostate cancer, decrease decision-making conflict and foster an active role for the patient in the decision,” explains Sofia Baptista, a CINTESIS researcher and the first author of this paper.
Although the results reveal a similar performance of the different formats, Carlos Martins considers that the tools of information based on web tools may be the most suitable to increase the capacity of men to participate in the decision making process for the PSA test, in an easy, anonymous and low cost way. “We need to insist on the creation of sites with high quality medical information, but that is clear and concise enough to be understood by the patients,” proposes the CINTESIS specialist.
In addition to Carlos Martins and Sofia Baptista, this study was supported by the researchers Elvira Teles Sampaio (from the Agrupamento de Centros de Saúde Porto Ocidental (Health Centers Group of Western Porto)), Bruno Heleno (from the NOVA University of Lisbon) and Luís Filipe Azevedo (from CINTESIS).