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Publication Briefs

Report Suggests Spaced Education Intervention Decreases Inappropriate Prostate Cancer Screening among Veterans

None of the major clinical practice guidelines (CPGs) recommend that prostate cancer screening with prostate-specific antigen (PSA) be routinely performed in asymptomatic males <40 years of age, >75 years of age, or with less than a 10-year life expectancy. And in 2008, the U.S. Preventive Services Task Force revised its guidelines to recommend specifically against PSA screening in men 75 years and older. This study tested an e-mail-based intervention called “spaced education” that was developed to reduce clinicians’ inappropriate screening for prostate cancer. Each of the spaced education (SE) e-mails presented a clinical scenario and asked whether a PSA test was appropriate; each one also contained an answer and explanation. Investigators randomized 95 primary care clinicians at eight VAMCs in the New England region into two groups: the spaced education group, in which clinicians received four cycles of nine e-mails over 36 weeks; and the control group, in which clinicians received no intervention. The trial was conducted from 1/07 to 2/09, with the primary outcome measure being the difference in the percentage of inappropriate PSA screening performed by VA clinicians participating in the intervention with those in the control group.


  • During the intervention period (36 weeks), clinicians who received the spaced education intervention ordered significantly fewer inappropriate PSA screening tests than clinicians in the control group (11% vs. 14%). Over the 72-week follow-up period, SE clinicians continued to order fewer inappropriate tests compared to controls (8% vs. 13%), representing a 40% relative reduction in inappropriate screening.
  • The impact of the intervention was unaffected by clincians’ age, gender, or provider type.


  • This study only tested spaced education in reducing inappropriate prostate cancer screening; results may not be the same when SE is applied for other purposes.


  • By facilitating the translation of CPGs into improved clinical care, spaced education interventions may offer a possible solution to the somewhat limited impact of CPGs on clinical practice.

This study was partly funded through HSR&D (TEL 02-100 and IIR 04-045). Dr. Kerfoot also was supported by an HSR&D Career Development Award.

PubMed Logo Kerfoot B, Lawler E, Sokolovskaya G, et al. Durable Improvements in Prostate Cancer Screening from Online Spaced Education: A Randomized Controlled Trial. American Journal of Preventive Medicine November 2010;39(5):472-78.

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