Randomized Trial of Veteran Peer Navigators to Promote Shared Decision Making for PSA Screening
VA Office of Research and Development
Summary
The project will investigate the efficacy of a Veteran-peer-navigator-led decision coaching (PDC) program to promote Shared Decision Making (SDM) for prostate cancer screening among Veterans at the Veterans Health Administration (VA). Prostate cancer is commonly screen detected using PSA, a non-specific test which has led to modest population-level survival benefits at the cost of over-detection of low-risk disease. This trade off in outcomes is ideally addressed using SDM which can be challenging to implement in time constrained primary care office visits. The investigators propose the evaluation of a PDC intervention to promote SDM for PSA screening to improve both access and quality of care for Veterans. The investigators results will enhance understanding of the efficacy, cost-effectiveness, and sustainability of PDC interventions for SDM promotion across communication formats in the VA. Lessons learned through this proposal will not only improve quality of care for PSA screening but also will suggest a paradigm for dissemination of SDM across preventive services.
Description
Prostate cancer is the most common non-cutaneous malignancy among men in the United States, accounting for one third of new cancer diagnoses in VA. Prostate Cancer is commonly detected using prostate-specific antigen (PSA), a non-specific test whose use in prostate cancer screening has led to modest population-level survival benefits at the cost of over-detection of low-risk disease. Recognizing this trade off, USPSTF and VHA Clinical Preventive Services recommend a Shared Decision Making (SDM) approach to PSA screening. Regardless of whether they ultimately elect PSA screening or not, patient…
Eligibility
- Age range
- 40–69 years
- Sex
- Male
- Healthy volunteers
- Yes
Inclusion Criteria: Veteran patient participants: * Age 40-69 years old * Veteran * Male * Attending VANYHHS-Manhattan for routine primary care appointment Providers: * Primary care provider at VA New York Harbor Healthcare System (VANYHHS) * Caring for patients that fit inclusion criteria Exclusion Criteria: Veteran Patients: * Patients seen within 9 months of other PSA tests * Patients seen within 180 days after primary diagnosis of urinary obstruction, prostatitis, hematuria, other disorder of prostate, unexplained weight loss, or lumbar back pain * Patients with a prior diagnosis of…
Interventions
- BehavioralVeteran Peer Decision Coaching Session for PSA Screening
Veterans in the intervention arm will review the content of the mailed DA, including the values clarification exercise, with the Veteran PDC. Veteran PDC Counseling includes: 1) a structured interview with the patient that focuses on determining his understanding of his prostate cancer risk, his screening options, and his goals and values related to his decision making and 2) role playing exercises to improve SDM skills.
Location
- VA NY Harbor Healthcare System, New York, NYNew York, New York