Durable Improvements in Prostate Cancer Screening from Online Spaced Education

Context Prostate cancer screening with prostate-specific antigen (PSA) is frequently performed, counter to clinical practice guidelines. Background It was hypothesized that an e-mail–based intervention termed "spaced education" could reduce clinicians' inappropriate screening for prostate cancer. Design The study was conducted as an RCT. Setting/participants The study involved 95 primary care clinicians in eight Veterans Affairs medical centers from January 2007 to February 2009. Intervention Participants were randomized into two cohorts: spaced education clinicians received four isomorphic cycles of nine e-mails over 36 weeks (zero to two e-mails per week), whereas control clinicians received no intervention. Each e-mail presented a clinical scenario and asked whether it was appropriate to obtain a PSA test. Participants received immediate feedback after submitting their answers. Main outcome measures The primary outcome was the number and percentage of inappropriate PSA screening tests ordered. Inappropriate testing was defined as use of PSA for prostate cancer screening in patients aged >76 or Results During the intervention period (Weeks 1–36), clinicians receiving spaced education e-mails ordered significantly fewer inappropriate PSA screening tests than control clinicians (10.5% vs 14.2%, p =0.041). Over the 72-week period following the intervention (Weeks 37–108), spaced education clinicians continued to order fewer inappropriate tests compared to controls (7.8% vs 13.1%, respectively, p =0.011), representing a 40% relative reduction in inappropriate screening. Conclusions Spaced education durably improves the prostate cancer screening behaviors of clinicians and represents a promising new methodology to improve patient care across healthcare systems.