Primary Care Physicians' Use of an Informed Decision-Making Process for Prostate Cancer Screening

Abstract

PURPOSE Leading professional organizations acknowledge the importance of an informed decision-making process for prostate cancer screening. We describe primary care physicians' reports of their prescreening discussions about the potential harms and benefi ts of prostate cancer screening. METHODS Members of the American Academy of Family Physicians NationalResearch Network responded to a survey that included (1) an indicator of practice styles related to discussing harms and benefi ts of prostate-specifi c antigen testing and providing a screening recommendation or letting patients decide, and (2) indicators refl ecting physicians' beliefs about prostate cancer screening. The survey was conducted between July 2007 and January 2008. RESULTSOf 426 physicians 246 (57.7%) completed the survey questionnaire. Compared with physicians who ordered screening without discussion (24.3%), physicians who discussed harms and benefi ts with patients and then let them decide (47.7%) were more likely to endorse beliefs that scientifi c evidence does not support screening, that patients should be told about the lack of evidence, and that patients have a right to know the limitations of screening; they were also less likely to endorse the belief that there was no need to educate patients because they wanted to be screened. Concerns about medicolegal risk associated with not screening were more common among physicians who discussed the harms and benefi ts and recommended screening than among physicians who discussed screening and let their patients decide.CONCLUSIONS Much of the variability in physicians' use of an informed decisionmaking process can be attributed to beliefs about screening. Concerns about medicolegal risk remain an important barrier for shared decision making.

Adult Patients’ Perspectives on the Benefits and Harms of Overused Screening Tests: a Qualitative Study

“…Study participants were asked to discuss their experiences with the benefits and harms of screening. However, because providers sometimes order tests without discussing them with patients 59 , patients in our study did not always remember receiving screening tests, and thus it is not surprising that some had difficulty discussing their experiences with and perceptions of the benefits and harms of screening. Another limitation is that we asked only about factors affecting screening decisions in the context of four specific screening tests.…”

National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening

“…18,19,21,41 Most PSA screening occurs with incomplete or no physician-patient discussion of its associated advantages, disadvantages, and uncertainty. These elements of shared decision making occur at different rates and are associated with different factors, suggesting variation in specific shared decision-making practices for individual patients.…”

“…National surveys have shown that many men who undergo PSA screening are poorly informed, and screening decisions are typically made by clinicians alone. [17][18][19][20][21] PSA screening in the absence of shared decision making exposes men to its potential harms without their knowledge and has been a dominant focus of policy debates. 4,17,19,22 The USPSTF's revised guidelines address this problem by not only discouraging routine screening, but recommending that physicians "should not offer or order PSA screening unless they are prepared to engage in shared decision making."…”

Evaluating the Use of Prostate-Specific Antigen as an Instrument for Early Detection of Prostate Cancer beyond Urologists: Results of a Representative Cross-Sectional Questionnaire Study of General Practitioners and Internal Specialists

“…Optimally, urologists' diagnostic approaches should be consistent with German interdisciplinary guidelines and the recently published results of the ERSPC and the PLCO trial. On the other hand, it has to be assumed that most men will initially contact their general practitioner (GP) or internal specialist (IS) for early detection of PCa [7,8,9,10]. Evidence is lacking about the proportion of population-based PCa screening initiated by GPs and ISs.…”