Understanding Prostate Cancer Risk and the Importance of Informed Choice
Prostate cancer is the most common cancer affecting men in the UK, with over 52,000 new diagnoses and 12,000 deaths annually. Historically, the UK has followed an “informed choice” policy for prostate-specific antigen (PSA) testing, where the test is available to any man aged 50 or over upon request, but only after being informed of the potential benefits and harms.
This approach aims to empower men to make an informed decision about whether PSA testing is right for them. However, research has shown that such “informed choice” policies can exacerbate health inequalities, as PSA testing rates tend to be higher among men in older age groups, from less deprived areas, and living in the South of the UK.
To address these issues and support men in making an informed choice, Prostate Cancer UK launched an online “risk checker” tool in September 2020. The tool aims to help men understand their prostate cancer risk factors and decide whether a PSA test is the right choice for them.
Evaluating the Effectiveness of the Prostate Cancer UK Risk Checker
To assess the impact of the risk checker, Prostate Cancer UK conducted a mixed-methods study involving surveys, focus groups, and one-on-one interviews with 1,181 men at risk, their partners, and clinical experts.
The study revealed several key insights:
Overcoming Assumptions About Testing
The research found a strong assumption among men that testing must be good, and a need to emphasize the pros and cons of the PSA test, and that the decision to have it is ultimately the patient’s. Many men believed their GP would invite them for PSA testing, highlighting the importance of clear communication around the informed choice policy.
Engaging Men at Risk
The data showed that 79.6% of men who completed the risk checker had at least one prostate cancer risk factor, suggesting the tool was effective in reaching the target audience. On average, men spent 9 minutes and 28 seconds interacting with the information in the tool, and 75.7% felt it had equipped them to make an informed choice.
Improving Informed Choice
The study demonstrates that online decision-making tools like the risk checker can effectively support men in engaging with prostate cancer information and making an informed choice about PSA testing. This is particularly important given the challenges primary care professionals face in providing balanced information on the harms and benefits of PSA testing during routine appointments.
Reaching Higher-Risk Patients Through Primary Care
To further assess the impact of the risk checker, Prostate Cancer UK worked with general practices in Bristol and London to send text messages to higher-risk patients, inviting them to use the tool and request a PSA test if desired.
The results showed that this approach helped primary care teams reach men who may have otherwise faced barriers to accessing PSA testing, particularly during the COVID-19 pandemic. Importantly, the text messages did not result in an unmanageable increase in workload for the practices, as men could request a PSA test without an additional appointment.
Addressing Health Inequalities and Improving Prostate Cancer Outcomes
The Prostate Cancer UK risk checker was launched at a critical time, as the COVID-19 pandemic had led to a significant reduction in prostate cancer diagnoses and treatments. By promoting informed decision-making about PSA testing, the tool aimed to help address these gaps and support earlier diagnosis.
While the study did not directly measure the impact on prostate cancer outcomes, the researchers note that real-world data showed an increase in the number of men receiving treatment for urological cancers during the same period that the risk checker was widely used.
Furthermore, the study’s findings suggest that online tools like the risk checker can help reduce the inherent health inequalities associated with “informed choice” policies for PSA testing. By effectively reaching men at higher risk and empowering them to make an informed decision, the risk checker has the potential to improve prostate cancer outcomes and reduce disparities in diagnosis and treatment.
Ongoing Evaluation and Refinement
The Prostate Cancer UK risk checker has undergone several iterations based on the insights gained from the study. The research team continues to evaluate the messaging and content to ensure it is presented in a balanced way that helps men make a fully informed choice.
As new evidence emerges and the understanding of prostate cancer screening and treatment evolves, the risk checker will need to be regularly updated to provide men with the most accurate and up-to-date information. Ongoing collaboration with primary care providers and further research on the tool’s long-term impact will also be crucial to its continued effectiveness.
Conclusion
The Prostate Cancer UK risk checker demonstrates the potential of online decision-making tools to address the challenges associated with “informed choice” policies for prostate cancer screening. By effectively reaching men at risk, providing balanced information, and empowering them to make an informed decision, the risk checker has the ability to improve prostate cancer outcomes and reduce health inequalities.
As the UK’s approach to prostate cancer screening continues to evolve, tools like the risk checker will play an increasingly important role in supporting men’s help-seeking behavior and ensuring they have the knowledge and confidence to make the right choice for their individual circumstances. The IT Fix blog is proud to recommend the Prostate Cancer UK risk checker as a valuable resource for men looking to understand and manage their prostate cancer risk.
To learn more about the risk checker and access the latest information, please visit the Prostate Cancer UK website.
