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Background: The UK has an informed choice testing policy for prostate cancer. The prostate-specific antigen (PSA) blood test is available for free to any man aged ≥50 years who requests it and has been informed of the harms and benefits. This policy leads to differences in PSA testing rates, which can exacerbate health inequalities. Aim: To assess whether Prostate Cancer UK’s risk checker helps men at risk of prostate cancer make an informed choice about the PSA test. Design & setting: Mixed-methods study in the UK. Method: In total, 1181 men at risk, their partners, and clinical experts participated in surveys, focus groups, and one-to-one interviews. Data on risk checker completions by sociodemographic factors were analysed over time. Data from general practices that sent the risk checker to their patients were collected and analysed for service monitoring purposes. Results: There was a strong assumption that testing must be good, and therefore a need to emphasise the pros and cons of the test and that having it was the patient’s decision. Men believed their GP would invite them for PSA testing. On the impact of the risk checker, 79.6% of men who completed it had at least one prostate cancer risk factor; the average time they interacted with the information in the tool was 9 minutes 28 seconds; and 75.7% felt the tool had equipped them to make an informed choice. Conclusion: Online decision-making tools, such as the risk checker, can help reach men at high risk of prostate cancer and support them in making an informed choice about the PSA test. [ABSTRACT FROM AUTHOR]

Background/Aims Induction of labour is an increasingly common intervention. This study's aim was to explore women's experiences of induction, in particular of decision making and choice. Methods A cross-sectional study was carried out with women who were induced with live, term infant(s) in two urban trusts. Their experiences were assessed using a postal survey that included the birth satisfaction scale and open questions on women's experiences. Chi-squared and Fisher's exact tests were used to test for associations between aspects of the induction process and women's characteristics (age, parity, ethnic group). Qualitative data were analysed thematically. Results Half (52.9%) of the respondents reported waiting to start induction. The majority felt sufficiently involved in decision making (62.1%) and choice (59.6%). Most reported having enough information about the reason for (82%) and process of (83%) induction. The qualitative themes were emotional response, communication, feeling unheard, quality of care and the negative impact of COVID-19 policies. Conclusions Women's overall experiences were positive. Improvements should focus on reducing delays to induction. [ABSTRACT FROM AUTHOR]

Anastrazole has recently been approved for the prevention of breast cancer in high-risk women in the UK. When given to high-risk women anastrazole halves the risk of developing breast cancer but doesn't reduce the risk of breast cancer death and is associated with significant harms. Women need to be counselled about both the benefits and risks associated with anastrazole use to enable an informed treatment choice. [ABSTRACT FROM AUTHOR]

Background: Professional guidelines recommend midwives and obstetricians actively involve women in making decisions about their care. To date, breech research has focused mainly on assessing the effectiveness of different management options. Aim: This research explores women's experience of breech presentation and their perception of choice and support in making decisions with regards to breech management. Methods: This study uses a phenomenological research design. Semi-structured interviews took place in hospital or women's homes. A total of six postnatal women who were diagnosed with breech presentation after 36 weeks' gestation took part in the study. Data was analysed using Colaizzi's method. Findings: A total of 84 significant statements were clustered into four main emerging themes. These include women's feelings, their healthcare expectations, their preferences and their values. Results: Breech discussions mostly occurred between obstetricians and women. These primarily focused on external cephalic version, Elective Lower Segment Caesarean Section and Breech Vaginal Birth. These options did not always become choices available to women. [ABSTRACT FROM AUTHOR]

Deafness can have a significant impact on a child's language, communication and social development. With the advent of the newborn hearing screening programme in the UK, the identification of deafness can happen a few weeks after birth. This article explores the components of effective early intervention services that should be paired with early identification, so that deaf children have the best possible start in life. [ABSTRACT FROM AUTHOR]

This study explored knowledge of cervical cancer risk factors among cervical screening non-participants in Great Britain. The aim was to identify knowledge gaps that could be targeted in screening information materials or public education campaigns. We used a cross-sectional design to survey women aged 25 to 64 years living in Great Britain, identified as cervical screening non-participants through self-report questions. Data were collected via a household survey. Survey questions measured awareness of risk factors for cervical cancer and socio-demographic factors. Screening non-participants were included in the study (n = 793) and classified into non-participant groups based on the Precaution Adoption Process Model. Across the sample, 57% of participants identified 'not going for regular smear tests' as a risk factor for cervical cancer. Women who intended to be screened were more likely to identify this risk factor than other non-participant groups (OR = 2.13, 95% CI: 1.51-2.99). Women age 55-64 years (OR = 0.60, 95% CI: 0.39-0.93) and women from non-white ethnic backgrounds (OR = 0.70, 95% CI: 0.52-0.94) were less likely to recognise this risk factor. Recognition was lower for 'infection with human papillomavirus' (41%). Just over half the sample were aware that screening non-attendance is associated with increased cervical cancer risk, suggesting that non-attendance at screening is not always based on an accurate understanding of the offer. Overall, non-participants are poorly informed about cervical cancer risk factors and further work is needed to ensure that women are making informed choices about (non-) participation. [ABSTRACT FROM AUTHOR]

The majority of individuals in the UK opting to terminate a pregnancy complicated by fetal anomaly have a medical rather than a surgical termination. This study provides context, understanding and evidence of the value that they attach to having the option to choose a termination method following a diagnosis of fetal anomaly. Ten women attending a fetal medicine unit participated in qualitative interviews by telephone and in person, explaining decision-making processes for their choice of method, their views on having this choice, and their perception of the value and acceptability of this choice. Important factors included the opportunity to confirm the fetal anomaly, hospitalisation, waiting time, and duration of the process. The emotional effort of carrying the pregnancy was foremost for many women, as was the need for self-preservation from birth trauma. Choice of termination method was felt to be a right for an individual facing a fetal anomaly. • Individuals should be offered a choice of termination method for fetal anomaly and supported to make an informed choice • Individuals require support during the time between the decision to terminate and the procedure, and directly afterwards. • Options for pain management for a medical termination and the choice not to have sight of the fetus should be offered. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the introduction of non‐invasive pre‐natal testing for Down's syndrome (DS) has the potential to undermine informed choice. Participants: Three hundred and ninety‐three health professionals; 523 pregnant women. Methods: A cross‐sectional questionnaire study across nine maternity units and three conferences in the UK designed to assess opinions regarding test delivery and how information should be communicated to women when offered Down's syndrome screening (DSS) or diagnosis using invasive (IDT) or non‐invasive testing (NIPT). Results: Both pregnant women and health professionals in the NIPT and DSS groups were less likely than the IDT group to consider that testing should take place at a return visit or that obtaining written consent was necessary, and more likely to think testing should be carried out routinely. Compared to health professionals, pregnant women expressed a stronger preference for testing to occur on the same day as pre‐test counselling (P = 0.000) and for invasive testing to be offered routinely (P = 0.000). They were also more likely to indicate written consent as necessary for DSS (P = 0.000) and NIPT (P < 0.05). Conclusions: Health professionals and pregnant women view the consenting process differently across antenatal test types. These differences suggest that informed choice may be undermined with the introduction of NIPT for DS into clinical practice. To maintain high standards of care, effective professional training programmes and practice guidelines are needed which prioritize informed consent and take into account the views and needs of service users. [ABSTRACT FROM AUTHOR]

Background: Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM). Methods: A literature search was carried out in a variety of lay and medical databases. Inclusion criteria: written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options. Results: Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid. Conclusions: There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of health screening interventions aimed at enhancing informed choice. Methods: Studies were selected if (1) they were randomized controlled trials conducted between January 1, 2000, and March 30, 2010, (2) participants in one arm under­went a prescreening intervention aimed at improving informed choice, and (3) in­formed choice was the primary outcome. Results: Eight studies that met the in­clusion criteria involved screening for prostate, colorectal and breast cancer, and diabetes. Five of the 8 prescreen­ing interventions led to greater informed choice. Conclusions: With researchers mindful of the limited number of stud­ies, findings were encouraging, but con­clusions regarding the most effective ways of facilitating informed choice for screening are at best tentative. [ABSTRACT FROM AUTHOR]

Abstract: Informed choice is internationally recognised and accepted as an important aspect of ethical healthcare. In the UK, NHS antenatal screening policies state that their primary aim is to facilitate reproductive informed choices. These policies, implemented within a multiethnic population, are largely guided by the ethical principle of autonomy. This study was carried out in 2009 in the UK and used Q-methodology to explore diversity in the value attached to autonomous informed choice in antenatal screening for genetic disorders and similarities and differences in this value in women from different ethnic origins. Ninety-eight participants of African, British White, Caribbean, Chinese and Pakistani origin completed a 41-statement Q-sort in English, French, Mandarin or Urdu. Q-Factor analysis produced five statistically independent viewpoints of the value of informed choice: choice as an individual right; choice informed by religious values; choice as a shared responsibility; choice advised by health professionals; and choice within the family context. The findings show that women hold a variety of views on the nature of informed choice, and that, contradictory to policies of autonomous informed choice, many women seek and value the advice of health professionals. The findings have implications for the role of health professionals in facilitating informed choice, quality of care and equity of access. [Copyright &y& Elsevier]

Abstract: Aim: To determine longer term health outcome in a cohort of UK service personnel who received the anthrax vaccination. Method: We conducted a three year follow up of UK service personnel all of whom were in the Armed Forces at the start of the Iraq War. 3206 had been offered the anthrax vaccination as part of preparations for the 2003 invasion of Iraq. A further 1190 individuals who did not deploy to Iraq in 2003 were subsequently offered the vaccination as part of later deployments, and in whom we therefore had prospective pre-exposure data. Results: There was no overall adverse health effect following receipt of the anthrax vaccination, with follow up data ranging from three to six years following vaccination. The previous retrospective association between making an uninformed choice to receive the anthrax vaccination and increased symptom reporting was replicated within a longitudinal sample where pre-vaccination health was known. Conclusions: Anthrax vaccination was not associated with long term adverse health problems. However, symptoms were associated with making an uninformed choice to undergo the vaccination. The results are important both for the safety of the vaccine and for future policies should anthrax vaccination be required in either military or non military populations. [Copyright &y& Elsevier]

Abstract: This paper reports on a qualitative study examining everyday practices of healthy living (HL). Forty-four semi-structured interviews were undertaken with Canadian and UK citizens, aged 45 – 70, in April–May 2010. The research sits within the now substantial literature concerned with how health information is mediated, both by people and technologies, and employed in the context of ‘good’ health citizenship. Throughout this work, notions of ‘choice’ and ‘empowerment’ have been interrogated, theoretically and empirically, to reveal both the knowledge/power relationships integral to ‘informing’ processes and the shifting relationship between information and care in contemporary health encounters. In this paper, we analyse how people make sense of what it means to live healthily and how they know if they are doing so by focussing on three ways in which study participants become informed about healthy living: through their engagement with universal HL messages, through their own information searches, and through their attempts to measure their ‘healthiness’. Following critique of the “logic of choice” in contemporary healthcare, we understand healthy living as a “situation of choice” where complex problems are framed as simple matters of choice and where information and technologies are understood as neutral aids to decision-making in support of ‘correct’ choices. Our analysis builds on and extends Mol’s work by exploring how participants negotiate between this “logic of choice” and her alternative “logic of care” in their accounts of everyday HL informing practices and how the two logics “interfere” with one another. These accounts show resistance to the logic of choice through ‘calls for care’ but they also show clearly how the disciplining logic of choice works to (re)present such calls for care as failed attempts at healthy living, undermining the very practices the logic of choice seeks to encourage. [Copyright &y& Elsevier]

Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanction a change to consent procedures for prenatal diagnosis or otherwise render informed decision-making less important. We accept the claim that the absence of risk of miscarriage to some extent lessens the gravity of the decision to test compared with invasive methods of testing. However, we also claim that the definitive nature of the information received, and the fact that the information can lead to decisions of great significance, makes NIPD an important choice. This choice should only be made by means of a rigorous and appropriately supported decision-making process (assuming that this is what the pregnant woman wants). We conclude that, on balance, consent procedures for NIPD should mirror those for invasive testing, albeit without the need to emphasise procedure-related risk. [ABSTRACT FROM AUTHOR]

Decision aids help patients make informed treatment decisions. Values clarification (VC) techniques are part of decision aids that help patients assimilate the information with their personal values. There is little evidence that these techniques contribute to enhanced decision making over and above the provision of good quality information. To assess whether VC techniques are active ingredients in enhancing informed decision making and explain how and why they work. Participants were randomly assigned to one of three groups: (i) information only, (ii) information plus implicit task, (iii) information plus explicit task. Thirty healthy women from a UK University participated by making a hypothetical choice between taking part in a clinical trial and having the standard treatment for breast cancer. Verbal protocols were elicited by think-aloud method and content analysed to assess informed decision making; a questionnaire was completed after the decision assessing decision preference, perceptions of decisional conflict and ambivalence. Data were analysed using multivariate statistics. No participants changed their decision preference as a result of the VC techniques. Women in the explicit VC group evaluated more information in accord with personal values, expressed lower ambivalence, decisional uncertainty and greater clarity of personal values than those in the implicit VC and control groups. Feelings of ambivalence about both options were related to decisional conflict. Explicit VC techniques are likely to be active ingredients in decision aids. They work by enabling people to deliberate about the decision information in accord with their personal values, which is associated with a better decision experience. [ABSTRACT FROM AUTHOR]

Discursive perspectives argue that cervical screening carries social and moral meaning. Overlooked by research into the health needs of sexual minority women, previous literature that has examined uptake of cervical screening has instead targeted increasing attendance via information and service provision. In order to explore the diversity of meanings that British sexual minority women have about cervical screening, the Q-sorts of 34 sexual minority women were factor analysed by-person and rotated to simple structure using Varimax. The five factors are interpreted and discussed relative to competing discourses on information provision within cervical screening. The five accounts are labelled 'cervical screening is': an essential health check that women have the right to refuse; a woman's health entitlement; a vital test but degrading experience; a sensible thing to do; and an unnecessary imposition for some women. Critical approaches to informed choice are explored with attention to recent developments in cervical cancer prevention. Findings highlighting the need for affirmation of diversity within healthcare are considered in relation to existing criteria for UK national screening programmes. [ABSTRACT FROM AUTHOR]

Abstract: The principle of informed choice has been recently incorporated into cancer screening policy. However, there is limited empirical or theoretical work on informed choice in this particular context. The main aim of the study reported here was to explore the information needs of people invited for screening, and to gain insights into the relationship between the information they wanted and the choices they made. A qualitative study (nine focus groups and 15 individual interviews) was undertaken with people who had contrasting experiences (and outcomes) of either breast, cervical, or colorectal cancer screening at two locations in Scotland, UK. Findings suggest that lay people define and conceptualise informed choice differently from policy makers. The study also found that information about the disease was as important to people as information on the risks and limitations of screening. However, information may have little part to play in the choices people make. Rather, it may have more impact on outcomes such as satisfaction and anxiety. An explicit policy aim in promoting informed choice is to enhance patient autonomy and to prevent people from being deceived or coerced. However, this research shows that the provision of evidence-based information alone does not necessarily mean that an informed choice is made. People may not read, want, or understand the information, and, additionally, they may not be able to carry out their intended choice. There may be personal barriers, such as physical or mental health problems and language, or organisational barriers, such as the availability of the service/intervention and access. Therefore, the term ‘informed choice’ might not be useful in this context. [Copyright &y& Elsevier]

This article discusses some weaknesses in current research into young consumers’ abilities to comprehend and successfully manipulate food label information and describes the development of a research project through to an analysis of the pilot phase. The research programme identifies a method of measuring the effectiveness of state education in enabling the next generation of consumers to make informed food choices through the provision of appropriate tools and skills, both of which are necessary to fully understand a label's informational elements within a marketing context. The article also discusses the appropriateness of a quantitative questionnaire to measure the abilities and skills of individuals through the identification of some key comprehension dimensions required by modern food consumers. Finally, the article questions the appropriateness of the context in which information is provided to food consumers. Through a continuing programme of research, it is envisaged that a more appropriate context for certain elements important in the choice of a diet that is relevant to an individual's lifestyle may be proposed. [ABSTRACT FROM AUTHOR]

The aim of this prospective study is to assess the reliability and validity of a multi-dimensional measure of informed choice (MMIC). Participants were 225 pregnant women in two general hospitals in the UK, women receiving low-risk results following serum screening for Down syndrome. The MMIC was administered before testing and the Ottawa Decisional Conflict Scale was administered 6 weeks later. The component scales of the MMIC, knowledge and attitude, were internally consistent (alpha values of 0.68 and 0.78, respectively). Those who made a choice categorised as informed using the MMIC rated their decision 6 weeks later as being more informed, better supported and of higher quality than women whose choice was categorised as uninformed. This provides evidence of predictive validity, whilst the lack of association between the MMIC and anxiety shows construct (discriminant) validity. Thus, the MMIC has been shown to be psychometrically robust in pregnant women offered the choice to undergo prenatal screening for Down syndrome and receiving a low-risk result. Replication of this finding in other groups, facing other decisions, with other outcomes, should be assessed in future research. [Copyright &y& Elsevier]

For many years, public information about screening has been aimed at achieving high uptake but concerns are now being raised about this approach. There are several problems that have prompted these concerns. By giving information that emphasizes only the positive aspects of screening the autonomy of individuals is ignored, individuals feel angry when they perceive that they are let down by screening, symptoms may be disregarded because of the belief that screening gives full protection, health service staff carry the blame for problems that are in fact inherent in screening, and sound debate about policy and investment in screening is hampered by misunderstanding about the benefits and costs of screening. If we adopt instead an approach that makes explicit the limitations and adverse effects then a different set of problems will be encountered. We risk a reduction in uptake of screening and thus population benefits may reduce, those most likely to be deterred from accepting screening may be the most socially disadvantaged, there will be a cost in terms of staff time to explain screening more fully to participants, and cost-effectiveness could be reduced if uptake falls so low as to make services barely viable. In the UK current General Medical Council (GMC) advice to doctors about informed consent for screening makes it clear that full information should be given. The UK National Screening Committee has also signalled the need for a changed approach to information giving so that individuals are offered a choice based on appreciation of risks and benefits. It will take time for this approach to be fully reflected across the full range of UK screening programmes. New national information will be needed to assist staff in giving full information, and some aspects of policy, such as screening coverage targets for Health Authorities and General Practitioners, will need to be altered. There are many questions still to be answered about the kind of information needed to achieve informed participation, and about how it should be framed and communicated. These questions can begin to be addressed when there is clarity at national level about the purpose of information about screening. [ABSTRACT FROM AUTHOR]

Objective To develop a measure of informed choice. Conceptualization and measurement The measure is based on the following definition of an informed choice: one that is based on relevant knowledge, consistent with the decision-maker’s values and behaviourally implemented. The measure comprises an eight-item scale of knowledge, a four-item scale assessing attitudes towards undergoing the screening test and a record of test uptake. Participants Sixty-six women awaiting their first antenatal clinic appointments. Measure development In women offered a screening test in pregnancy, the internal reliability of both the knowledge and the attitude scales was acceptable (alpha coefficients 0.82 and 0.83, respectively). Of the 42 women completing both scales, 18 were classified as having made an informed choice, and 24 were classified as having made an uninformed choice. Conclusion The results of this preliminary study provide some evidence to support the feasibility of conceptualizing and measuring informed choices regarding screening using a brief measure assessing knowledge and attitudes. The validity and utility of this approach awaits further studies, involving larger numbers of participants, offered different screening tests. [ABSTRACT FROM AUTHOR]

This paper describes the process of developing a guidebook for people with ulcerative colitis by involving patients and self-help groups from the outset. Medical information in the guidebook is based on evidence of effective treatment obtained from results of randomized controlled trials reported in the medical literature. Such information is presented in a way designed to empower patients and allow them to participate in making informed choices about their medical and surgical care. Initial evaluation in the form of feedback from patients has shown that the guidebook is well liked and easy to understand. The principles used in the development could be extended to devise similar guidebooks for other chronic conditions. [ABSTRACT FROM AUTHOR]

The personal choices that people make are critical in enabling their engagement in meaningful occupation. Although choice is important, it has to be recognised that not all service users make informed choices to assist their recovery. This opinion piece explores the role of occupational therapists in facilitating informed choice in the light of service user empowerment and the Mental Capacity Act 2005. The opinion offered is the need to recognise the continuing role of occupational therapists in challenging some of the choices that service users make in order to enable their engagement in meaningful occupation, despite the current changes in policy and legislation. [ABSTRACT FROM AUTHOR]

Background The Teamwork Project is managed by the National Cancer Alliance (NCA) and funded jointly by the National Lottery Charities Board and the Department of Health. The aim of the Project is to produce a Personal Information File to help people with cancer work in partnership with health professionals. Phase one was carried out between September 1998 and April 2000. The Teamwork Project arose as a direct result of the NCA report, ‘Patient-Centred Cancer Services’? – What Patients Say,1 one of a number of studies that found people with cancer want to be involved in decisions about their treatment and care. The study also found that, for this involvement to be successful, health professionals need to support patients in accessing information relevant to their individual needs and help them understand and apply that information. The focus of The Teamwork Project is to help provide a practical solution to meeting this information need. Approach The Teamwork Project has used a wide-range of methods including literature appraisal; patient questionnaires; focus groups; semi-structured interviews and a consultation exercise. Throughout the Project there has been on-going involvement from both patients and professionals. Conclusions There may be a divergence of views among health professionals in cancer services regarding their role as providers of patient information. Consequently, there may also be a significant variance in how their patients are informed in practice. This finding needs to be validated and the reasons for this understood if the full potential of the forthcoming National Health Service (NHS) Cancer Information Strategy is to be realised. [ABSTRACT FROM AUTHOR]

Background: Field-testing is a quality assurance criterion in the development of patient decision-support technologies (PDSTs), as identified in the consensus statement of the International Patient Decision Aids Standards Collaboration. We incorporated field-testing into the development of a Web-based, prostate-specific antigen PDST called Prosdex, which was commissioned as part of the UK Prostate Cancer Risk Management Programme. Objectives: The aim of this study was to develop a model for the future field-testing of PDSTs, based on the field-testing of Prosdex. Our objectives were (1) to explore the reactions of men to evolving prototypes of Prosdex, (2) to assess the effect of these responses on the development process, and (3) to develop a model for field-testing PDSTs based on the responses and their effect on the development process. Methods: Semistructured interviews were conducted with the men after they had viewed evolving prototypes of Prosdex in their homes. The men were grouped according to the prototype viewed. Men between 40 and 75 years of age were recruited from two family practices in different parts of Wales, United Kingdom. In the interviews, the men were asked for their views on Prosdex, both as a whole and in relation to specific sections such as the introduction and video clips. Comments and technical issues that arose during the viewings were noted and fed back to the developers in order to produce subsequent prototypes. Results: A total of 27 men were interviewed, in five groups, according to the five prototypes of Prosdex that were developed. The two main themes from the interviews were the responses to the information provided in Prosdex and the responses to specific features of Prosdex. Within these themes, two of the most frequently encountered categories were detail of the information provided and balance between contrasting viewpoints. Criticisms were encountered, particularly with respect to navigation of the site. In addition, we found that participants made little use of the decision-making scale. The introduction of an interactive contents page to prototype 2 was the main change made to Prosdex as a result of the field-testing. Based on our findings, a model for the field-testing of PDSTs was developed, involving an exploratory field-testing stage between the planning stage and the development of the first prototype, and followed by the prototype field-testing stage, leading to the final PDST. Conclusions: In the field-testing of Prosdex, a Web-based prostate-specific antigen PDST, the responses of interviewed men were generally favorable. As a consequence of the responses, an interactive contents page was added to the site. We developed a model for the future field-testing of PDSTs, involving two stages: exploratory field-testing and prototype field-testing. [ABSTRACT FROM AUTHOR]