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To screen or not to screen? What role do web-based decision aids play in decision making around prostate cancer screening?

The Bottom Line

  • Experts disagree about the benefits and harms of prostate cancer screening via the prostate-specific antigen test.
  • Web-based decision aids may hold several benefits, including increasing patient knowledge on available screening options and outcomes vs. usual care. 
  • Web-based decision aids may be comparable to print-based decisions aids, and video-based decision aids in certain aspects. 
  • Consider using a decision aid for your own personal learning or to inform discussions with your health care provider.
  • The McMaster Optimal Aging Portal has several web-based decision aids specific to prostate cancer screening. Have a look through them below. 

Soup or salad, when the best time to retire is, what your end-of-life care wishes are. From the mundane to the life-altering, every day, we are faced with a laundry list of decisions that need to be made in order for us to move forward.


Health-related decisions, in particular, often come with a lot of complex and sensitive information to mull over, and their impact on our lives—be it positive or negative—has the potential to be substantial. As a result, these types of decisions can be incredibly difficult to make. Take, for example, whether or not to undergo prostate cancer screening.


The five-year survival rate for males with prostate cancer is approximately 100% if caught early vs. 30% if caught at a more advanced stage (1). If you‘re thinking, surely this helps to make the case for prostate cancer screening, think again. The decision to get screened, generally via the prostate-specific antigen (PSA) test, isn’t so cut and dry. In fact, some experts suggest that the benefits associated with the PSA test don’t outweigh the potential risks, while others suggest they do (2-4).


The decision to be screened for any disease, including prostate cancer, should involve the weighing of the pros and cons along with one’s personal preferences. It can be overwhelming to consider all of the factors. However, help is available in the form of patient decision aids. Patient decision aids come in print, video, and web-based formats, with the latter gaining increased attention due to the anonymity it provides and its affordability and accessibility (5).


What the research tells us

One systematic review looked at the effects of males using web-based decision aids for decision making around prostate cancer screening. The review found that web-based decision aids can increase knowledge—for instance around available screening options and associated outcomes—in males who use them vs. males who receive usual care.


Some evidence within the review also suggests the potential for several additional benefits and highlights a couple of interesting points. First, in comparison to usual care, web-based decision aids may decrease uncertainty around choosing between different options, and reduce decision making that’s controlled by a health practitioner. However, it may have no effect on patient participation in decision-making or prostate cancer screening behaviour, compared to usual care. Second, web-based decision aids may be comparable to printed decision aids with respect to patient knowledge, feelings of uncertainty about which choice to make, participation in decision making, and screening behaviour. Third, in comparison to those who use video-based decision aids, people using web-based decision aids may have lower levels of patient knowledge, and may slightly change screening behaviours by decreasing the use of PSA tests. With that said, because these results are based on a small number of studies, more research is needed to compare different decision aid formats, especially in the long-term, and to take a closer look at the features of web-based decisions aids (5).


If you: 1) are interested in being involved in decisions related to your health, 2) would simply like to be better aware of the options available to you, and/or 3) are gathering knowledge to inform discussions with your health care provider, consider trying one of the many different forms of decision aids available. Reflect on your own learning preferences (e.g., written, multimedia, or web), which aspect of the decision-making process you’d like to improve, and factors like access and cost when choosing a type of decision aid.

For those in favour of a web-based format or who are looking for a place to start, the McMaster Optimal Aging Portal helps link you to several quality-rated web-based decision aids on prostate cancer screening. Check them out below:


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References

  1. Hoffman RM. Patient education: Prostate cancer screening (Beyond the Basics). [Internet] 2020. [cited September 2020].
  2. Bell N, Gorber S, Shane A, et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ. 2014; 186:1225-1234. doi: 10.1503/cmaj.140703. 
  3. Fenton JJ, Weyrich MS, Durbin S, et al. Prostate-specific antigen-based screening for prostate cancer: Evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018; 319(18):1914-1931. doi: 10.10001/jama.2018.3712.   
  4. Gulati R, Tsodikov A, Etzioni R, et al. Expected population impacts of discontinued prostate-specific antigen screening. Cancer. 2014; 120:3519-3526. doi: 10. 1002/cncr.28932.
  5. Baptista S, Teles Sampaio E, Heleno B, et al. Web-based versus usual care and other formats of decision aids to support prostate cancer screening decisions: Systematic review and meta-analysis. J Med Internet Res. 2018; 20(6):e228. doi: 10.2196/jmir.9070. 
 

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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