Prostate cancer is one of the most prevalent cancers in men worldwide.1
The introduction and widespread use of the prostate-specific antigen (PSA) test as a diagnostic screening instrument has led to a significant increase in the detection of prostate cancer.1,2
Despite the high incidence of prostate cancer, many medical organizations offer conflicting recommendations as to the merits of screening for prostate cancer.3
Much of this debate is caused by the inadequacies of diagnostic screening tests, including the PSA test, and lack of high-quality evidence from randomized controlled trials (RCTs) of a salutary effect of prostate cancer screening on patient outcomes.3
This uncertainty will persist until long-term follow-up data from ongoing RCTs indicates whether screening offers clinically significant improvements in patient outcomes by reducing prostate-specific and all-cause mortality.3
In the absence of any definitive evidence on the merits of prostate cancer screening, greater emphasis is placed on the patient/doctor relationship, their interaction, and the ability of the patient to understand the potential benefits and risks of screening. Traditionally, the patient/doctor relationship has been paternalistic in nature, with the doctor acting as the gatekeeper of health information and guiding the decision-making process.4
Education materials have traditionally been used by health professionals to better inform patients and supplement discussions on specific health issues. Such materials, along with decision aids, can increase the effectiveness of decision making by reducing patients’ decisional conflict.5
Decisional conflict is defined as a state of uncertainty about a particular course of action.6
Patients will often experience decisional conflict when confronted with making a decision about a medical issue that has high trade-offs between benefits and harms, as is the case with screening for prostate cancer.
Patient education has traditionally been facilitated through written and audio-visual formats. More recently, increased public access to the internet has seen it develop as another potential patient education resource. The internet is a resource that allows patients to access health information anonymously, which can be beneficial when searching for information on patient-perceived sensitive issues such as prostate cancer.7
In addition, the internet allows users to access health information easier and in a format that is most suited to their learning style, accounting for different levels of education, language, and media.7,8
Despite such benefits, users must also overcome potential barriers including accessibility to the internet and expertise in searching for online health information.
The majority of patient education materials on prostate cancer to date have been facilitated through video and written formats. Both formats have been associated with an increase in patient health knowledge, a shift toward an active or shared decision-making process, a decrease in patient decisional conflict, and a preference to not undergo screening for prostate cancer.9–20
To date, only one study has investigated the effectiveness of the internet as a patient education tool for prostate cancer screening. It compared information delivered via the internet and video and identified increases in patient knowledge and a decrease in patient preference for prostate cancer screening across both interventions.11
There was no significant difference in knowledge scores between the interventions, however, statistically significantly fewer participants who were assigned to the video intervention requested a PSA test than those assigned to the internet intervention. Other RCTs, which have evaluated the effectiveness of the internet as a patient education source across a variety of health topics, have also concluded the potential for the internet as a viable method of delivering health information to patients.21–23
The aim of this study was to determine which format for delivering information about prostate cancer screening (video, internet, or written materials) has the greatest effects on patient decision making, attitudes, knowledge, and screening interest.