The efficacy of decision support E-Book for reducing decisional conflict on prostate biopsy decision making in patients with elevated serum prostate-specific antigen

• Main Authors: CHIU, PEI-PEI, 邱貝貝
• Other Authors: Wang,TSAE-JYY
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/42bp7r

碩士 === 國立臺北護理健康大學 === 護理研究所 === 107 === Background: Prostate cancer is the most common male urological cancer. Blood prostate-specific antigen (PSA) is an important index of prostate cancer. PSA check-up is the main test to detect prostate cancer. An elevated PSA test result is usually followed by the transrectal ultrasound-guided prostate biopsy(TRUS-Bx) for diagnosis of existing prostate cancer or not. However, the patients often concern physiological complications which may induce patients’ psychological stress and decisional conflict. Purpose: The purpose of this study was to investigate the efficacy of decision support E-Book on increasing prostate biopsy knowledge and decision self-efficacy, and reducing decisional conflict on prostate biopsy decision making in patients with elevated serum PSA. Methods: The study is based on an experimental design. A total of 110 adult males with a PSA greater than 4.0 ng/mL and the transrectal ultrasound-guided prostate biopsy suggested by a physician will be recruited from the urology outpatient department. The patients will be randomly assigned to the intervention and control groups. The patients in intervention group receive the biopsy decision support intervention delivered by a nurse using an E-Book. The control group patients received a written health education about prostate biopsy. The patients in both groups receive assessment by using the study questionnaires at pre and post-test. The study instruments include the prostate biopsy knowledge score, the Decision Self-Efficacy Scale(DSES), and the Decisional Conflict Scale(DCS). Data on whether the patients received a prostate biopsy will also be collected from the patients’ medical records. Chi-square test and independent sample t-test were used to compare the between group baseline equilibrium. Paired t-test was used to compare the difference of the scores between pre- and post-test in intervention and control groups. Analysis of Covariance (ANCOVA) was used to analyze the between group differences in biopsy knowledge, decision self-efficacy, and decisional conflict at post-test to evaluate the efficacy of the intervention with decision support-E book. Results: The mean age of the 110 patients was 69.11(SD=6.03) years, and the mean PSA was 9.85(SD=10.39) ng/mL. There was no statistically significant difference of the mean age and PSA between the intervention and control groups. The chi-square test showed that there were no significant difference of the education, marital status, current working status, and economic status between the two groups. The independent t-test, showed that there was a significant increase of prostate biopsy knowledge score in intervention group than that in control group [13.96(SD=2.52) vs. 9.52(SD=5.05), p<.001, 95% CI:3.22-4.77] at post-test. A significant increase of decision self-efficacy score was also noted in intervention group as compared with that in control group [84.01(SD=21.10) vs. 68.88(SD=31.87), p=.004, 95% CI:7.39-17.77] at post-test. There was a significant decrease of decisional conflict score in intervention group as compared with that in control group [12.10(SD=14.69) vs. 34.40(SD=26.53), p< .001, 95% CI: -18.80-(-28.50)] at post-test. The paired t-test showed, there was also a significant greater prostate biopsy knowledge score [8.90(SD=5.21)vs. 13.96(SD=2.52), p< .001] and decision self-efficacy score[62.31(SD=33.61) vs. 84.01(SD=21.10), p< .001], and less decisional conflict score [42.13(SD=32.32)vs. 12.10(SD=14.69), p< .001] in post-test as compared with that in pre-test in each of the two groups. The ANCOVA also showed a significant difference of prostate biopsy knowledge score and decision self-efficacy scale, and less decisional conflict scale between two groups at post-test (p < .001, p < .001, p < .001, respectively). Conclusions: The results of this study suggest that the prostate biopsy decision support E-Book may increase the patient's prostate biopsy-related knowledge and decision self-efficacy, and reduce decisional conflict. Relevance to clinical practice: To help the patients to express decision in personal values, build better physician-patient relationship, improve patient’s satisfaction with medical treatment, and achieve a higher quality of physical and mental care as well as a positive impact on the shared decision-making between physician and patient, and have the clinical value of subsequent promotion.