Informed Decision-Making for Prostate Cancer Screening: A Prospective, Randomized Study of 2 Novel Web-Based, Electronic Visits

Purpose: – The aim of this study was to conduct a quality improvement study testing 2 novel, web-based, electronic visits (E-visits) enabling men to make a decision regarding prostate cancer screening. Materials and Methods: – Three thousand two hundred screen-eligible men in Kaiser Permanente, Northern California, equally comprised of 4 self-reported race/ethnicity categories (Asian, Black, Hispanic, and White) were randomly assigned to one of 2 E-visits: one purely informational providing general information on the risks and benefits of screening (informational E-visit) and the second (interactive E-visit) incorporating a personalized estimate for the risk of having an elevated PSA level based on the patient’s age and race. Completion rates of the E-visits and whether a decision on screening was made were the main outcomes. Results: – The overall completion rate was similar by E-visit type (overall 15.6%, informational E-visit 16.2%, interactive E-visit 14.7%, P = .24). White men had the highest completion rate and Black men the lowest (18.5% vs 13.1%, P = .02). Older men aged 60 to 69 years had a higher completion rate than younger men aged 50 to 59 years (18.8% vs 15.4%, P = .045). Among those who completed an E-visit, those completing the interactive E-visit were more likely to make a decision regarding screening (98.7% vs 91.2%, P < .001) and were more likely to request a PSA test (96.2% vs 90.0%, P = .008) compared with those completing the informational E-visit. Conclusions: – Race and age were associated with completion rates of these E-visits. Among men completing the visit, those completing the interactive E-visit were more likely to make a decision regarding screening and order a PSA test than those completing the informational E-visit.