Table 1 The intervention structure and content

Video for Patients

1) To describe key messages about prostate cancer screening

1) Key messages:

· There are two kinds of prostate cancer—harmless and dangerous

· A problem with the PSA test is that it leads some men with a harmless prostate cancer to get treatment that they do not need.

· About half of all men who get treatment for prostate cancer will have permanent side effects

· Men should decide whether the PSA test is right for them and talk with their doctor.

2) To model the process of learning and deciding about prostate cancer screening

2) Modeling:

· 4 men engage in an after-hours discussion with their physician

· Each man participates in questioning and reasoning about screening

3) To facilitate values clarification via a process of social matching with two men making opposite decisions using the same facts

Values Clarification:

· Joe decides to get the PSA test after considering the facts

· Frank decides NOT to get the PSA test after considering the facts

Coaching Session for Patients

1) To answer men’s questions about prostate cancer screening by providing a supplemental educational brochure

1) Key facts:

· Location of the prostate

· Characteristics of the PSA test

· Characteristics of prostate cancer

· Risk factors for prostate cancer

· Treatment options and their side effects

2) To help men clarify their values for screening by ranking and rating decisional attributes

2) Decisional Attributes:

· Magnitude of the problem (e.g. prostate cancer)

· Benefit in knowing one has prostate cancer

· The (un)certainty of the PSA test

· The (un)certainty of treatment outcomes

· Worry about treatment side effects

3) To help men prepare for a discussion with their doctor by delivering tailored messages about discussion barriers and by providing a pad on which to write their screening decision and any questions for their doctor

2) Barriers to Discussion:

· Discomfort asking questions

· Fear of expressing opinions

· Difficulty interrupting the doctor

· Difficulty disagreeing with the doctor

· Worry about taking too much of the doctor’s time

· Difficulty understanding medical jargon

· Embarrassment asking questions

Education Session for Providers

1) To review the evidence for prostate cancer screening

1) Evidence:

· Natural History of prostate cancer

· Lack of clear benefit of prostate cancer screening

· Certain harms of screening and early treatment

2) To highlight the value of shared decision making for prostate cancer screening

2) Value of Shared Decision Making:

· Ethical obligation to consider patient preferences in the face of uncertain outcomes