Veteran Peer Navigators to Promote Shared Decision Making for PSA Screening

The 16-item Decisional Conflict Scale (DCS) measures Veterans' perceptions of 1) uncertainty in choosing options, 2) feelings of having adequate knowledge and clear values, and 3) effective decision making. DCS is scored on a 5-point Likert scales with scores ranging from 0 (no decisional conflict) to 100 (extremely high decisional conflict)

The Patient Knowledge Survey comprises of 12-items assessing prostate cancer and PSA screening knowledge. Respondents provide an answer of "True", "Unsure", or "False". The total score is the sum of correct responses and ranges from 0 - 12 with higher scores indicating greater knowledge levels.

Decision quality will be measured through 3 domains: 1) decisional conflict 2) being informed (e.g. accurate understanding about screening and its risks and benefits) and 3) making preference-concordant decisions (i.e. treatment consistent with patient preferences). The Decision Quality Balance Scale consists of 12 questions (6 Pros and 6 Cons of testing) scored on a 5 point Likert scale (Strongly Disagree to Strongly Agree) that represents the relative strengths of the pros versus the cons and ranges from -24 to +24. A high quality decision is when patients are both well-informed and making preference-concordant decisions (i.e. treatment consistent with patient preferences as determined by responses to survey questions).

Percentage of participants who receive at least one PSA screening test. Screening data is collected through patient self-report and electronic health record data.

The percentage of participants who make an informed choice to either undergo or decline PSA testing. Informed choices are those in which:

• Men with good knowledge and positive measure of informed choice attitudes (> or = 22) choose to undergo the test OR 2) Men with good knowledge but negative measure of informed choice attitudes (<22) towards the test, do not undergo the test.

The measure of Informed Choice evaluates the screening decision. The 4-item measure consists of items assessing knowledge, attitude towards the screening test, and a record of test uptake. The questions are graded on a 7 point Likert-type scale (1 to 7) with scores ranging from 4 to 28. The median of 22 was taken to classify men's attitudes as positive or negative, with scores 22 or above indicating positive attitudes, and those below 22 indicating negative attitudes.

Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness (COMRADE) is a 20-item measure validated for clinical encounters with sub-scales in 1) satisfaction with physician communication and 2) patient confidence in the decision. The scale is graded on a 5 point Likert scale (1 to 5) with a range from 1 to 100 maximum. Higher scores indicate higher satisfaction with communication.

The Questionnaire Concerning Doctor-Patient Communication Skills is a validated 19 item scale that captures process (greeting, listening) and content (explanations and next steps) aspects of the visit from the provider's and patient's perspectives. The questions are scored on a 5-point Likert scale (1 Strongly Disagree to 5 Strongly Agree) with Higher scores (4-5) indicating satisfaction with provider communication

The Decision Self-Efficacy Scale is an 11 item scale measuring self-efficacy to perform informed decision making (e.g. getting needed information, asking questions, expressing opinions, and asking for advice). The questions are scored on a 5-point Likert scale (0 Strongly Disagree to 4 Strongly Agree) and range from 0 (not at all confident) to 100 (very confident).

Perceived Efficacy in Patient-Physician Interactions is a 10-item scale measuring self-efficacy for communicating with a provider. The questions are scored on a 5-point Likert scale (1 Not at all confident to 5 Very confident) with a range of possible scores from 10 to 50 (highest patient perceived self-efficacy for communicating with provider).

The SWD is a 6-item measure assessing patient satisfaction with their decision and the decision making process. The questions are scored on a 5-point Likert scale (1 Strongly Disagree to 5 Strongly Agree). Higher scores indicate higher satisfaction with decision (scores range from 1-5).

The Decisional Regret Scale is a validated, 5-item scale measuring regret or remorse following a health care decision. Questions are scored on a 5-point Likert scale (5 Strongly Disagree to 1 Strongly Agree). Scores range from 0 (means no regret) to 100 (means high regret).