Do Decision Aids Make a Difference in Prostate Cancer Screening? Interview with:

Kari Tikkinen, MD, PhD, Adjunct Professor Departments of Urology and Public Health University of Helsinki and Helsinki University Hospital Helsinki, Finland

Dr. Tikkinen

Kari Tikkinen, MD, PhD, Adjunct Professor
Departments of Urology and Public Health
University of Helsinki and Helsinki University Hospital
Helsinki, Finland What is the background for this study? What are the main findings? 

Response: Men’s choice of whether to undergo screening is value and preference sensitive: fully informed men will make different choices depending on their experience and perspective. For such decisions, shared decision-making represents an ideal approach to decision making. In shared decision-making both the patient and health care provider contribute to the medical decision-making process. The health care provider explains alternatives to patients, informs them of the best evidence regarding the anticipated consequences of a decision for or against the intervention, and helps them choose the option that best aligns with their preferences. All major guidelines of prostate cancer screening acknowledge the importance of informing men about risks and benefits of PSA screening.

Shared decision-making is challenging because it requires time, knowledge, and specific skills. Prostate cancer screening decisions aids may, by summarizing the current best evidence and by supporting conversations that address what matters most to men, address these challenges. The impact of decision aids on the decision-making process is, however, uncertain. We therefore undertook a systematic review and meta-analysis of the randomized trials that have addressed the impact of decision aids in the context of prostate cancer screening. What should readers take away from your report? 

Response: Our results suggest a possible increase in knowledge and likely small decrease in decisional conflict (uncertainty about which course of action to take) but no apparent association with whether physicians and patients discussed prostate cancer screening or in men’s decision to undergo, or not undergo, prostate cancer screening. What recommendations do you have for future research as a result of this work? 

Response: Many prostate cancer screening decision aids are available online, but only a few have undergone formal testing. All decisions aids included in our review provided education to patients, but only one showed clear facilitation of screening discussions – that is, shared decision making. The results thus demonstrate a lack of prostate cancer decision aids specifically geared to facilitating shared decision making. Future decision aids should include provision for continuous updating, provide education, and promote shared decision making in the patient-physician encounter.

I have no financial conflicts of interest. 


Riikonen JM, Guyatt GH, Kilpeläinen TP, et al. Decision Aids for Prostate Cancer Screening ChoiceA Systematic Review and Meta-analysisJAMA Intern Med. Published online June 24, 2019. doi:10.1001/jamainternmed.2019.0763


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