# Randomized trial of Veteran peer navigators to promote Shared Decision Making for PSA screening

> **NIH VA I01** · VA  MEDICAL CENTER · 2024 · —

## Abstract

Background: Prostate cancer is the most common non-cutaneous malignancy among men in the United
States, accounting for one third of VA’s new cancer diagnoses. The United States Preventive Services Task
Force (USPSTF) and VHA Clinical Preventive Services guidance recommend a Shared Decision Making
(SDM) approach to prostate-specific antigen (PSA) screening due to the tradeoff between modest population-
level survival benefits and the cost of over-detection of low-risk disease.
Significance: The limited time available for primary care office visits makes covering all the beneficial
USPSTF recommendations challenging. USPSTF and VHA Clinical Preventive Services recommend a SDM
approach for PSA screening decisions where patients discuss the best evidence for and against screening with
clinicians and are supported to make high quality decisions. SDM is underutilized in clinical practice and is
rarely achieved in prostate cancer screening decisions. Veteran peer navigators are ideal decision coaches to
improve patient knowledge and promote SDM among Veterans. We propose a Veteran-peer-navigator-led
decision coaching (PDC) program for PSA screening to promote SDM and potentially lighten the burden of this
type of counseling for VA primary care providers. Preliminary data will be collected to inform workflow
improvements addressing HSRD priorities of access and quality of care, since SDM is a required quality of
care goal that is yet to be universally implemented among PCPs.
Innovation and Impact: 1) The novel use of Veteran peer navigators in a “deliberative” role to promote and
facilitate SDM with Veteran patients and their providers is responsive to the USPSTF and HSR&D research
priorities. 2) The project will assess the PDC intervention’s workflow effects from the perspectives of key
stakeholders, including Veterans, peer navigators, and clinicians. This study will comprehensively assess the
effects of a PDC intervention among Veterans and providers, additionally exploring workflow considerations
and factors critical to dissemination. 3) The project will address the cost implications and sustainability of the
decision coaching intervention. 4) The intervention is tailored for current health care delivery, including the use
of telehealth.
Specific Aims: Aim 1: Test the effect of PDC on decision quality, Veteran-provider communication, and
screening experience for Veterans considering PSA screening using validated surveys and theory-based
qualitative interviews. Aim 2: Evaluate PDC’s effect on provider and administrator experience with PSA
counseling and clinic workflow using validated surveys and theory-based qualitative interviews. Aim 3:
Determine the cost and budget impact of a PDC program for PSA screening.
Methodology: The objective in this proposal is to test the efficacy of a PDC program to facilitate SDM for PSA
screening among Veterans at VA New York Harbor Healthcare System. We will randomize Veterans seeking
primary care to receive 1) a sta...

## Key facts

- **NIH application ID:** 10862260
- **Project number:** 1I01HX003622-01A2
- **Recipient organization:** VA  MEDICAL CENTER
- **Principal Investigator:** DANIL V. MAKAROV
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-09-01 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10862260

## Citation

> US National Institutes of Health, RePORTER application 10862260, Randomized trial of Veteran peer navigators to promote Shared Decision Making for PSA screening (1I01HX003622-01A2). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10862260. Licensed CC0.

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