Discussions About Prostate Cancer Screening Between U.S. Primary Care Physicians and Their Patients

Hall, Ingrid J.; Taylor, Yhenneko J.; Ross, Lone; Richardson, Lisa C.; Richards, Thomas B.; Rim, Sun Hee

doi:10.1007/s11606-011-1682-0

Cited by 21 publications

(33 citation statements)

References 21 publications

(25 reference statements)

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“…Although the U.S. Preventive Services Task Force (USPSTF) recommended against routine screening of asymptomatic men in 2012, recent studies show that providers continue to screen for prostate cancer in about 25%–30% of men of screening age (Li et al, 2015; Drazer et al, 2015; Jemal et al, 2015). As an update to prior reports on primary care physician (PCP) practices around PSA screening (Hall et al, 2011a; Richards et al, 2012), our study reports 2016 data on physicians’ screening behaviors and beliefs about PSA testing for screening asymptomatic men, and factors that affect physicians’ decisions to recommend (or not recommend) screening. Revised prostate cancer guidelines are currently being finalized (in 2017) and recommend that men 55–69 years make an individualized screening decision together with their physician.…”

Section: Introductionmentioning

confidence: 99%

Prostate-specific antigen screening: An update of physician beliefs and practices

Hall

Rim

Massetti

et al. 2017

Preventive Medicine

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PSA testing for early detection of prostate cancer decreased dramatically following the 2012 PSA screening recommendation against routine screening of asymptomatic men. In an assessment of the screening behaviors of primary care providers, the majority (61%) of family medicine and internal medicine practitioners who responded to a 2016 DocStyles online survey (608 of 1003) recommended prostate-specific antigen (PSA) testing based on individual risk or other factors, rather than routinely screening all men for prostate cancer.

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Section: Introductionmentioning

confidence: 99%

Prostate-specific antigen screening: An update of physician beliefs and practices

Hall

Rim

Massetti

et al. 2017

Preventive Medicine

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“…Each year approximately 40% to 50% of men aged 50 years and older undergo PSA screening, 1 often without their knowledge. [2][3][4][5][6] The test has become so routine that in one highly publicized case a physician was sued for malpractice for not ordering it.…”

Section: Introductionmentioning

confidence: 99%

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

Han

Kobrin

Breen

et al. 2013

The Annals of Family Medicine

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PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making.METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics.RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making.CONCLUSIONS Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.

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“…This differs from the National Survey of Primary-Care Physician Practices Regarding Prostate Cancer Screening which reported that 80% of PCPs reported discussing PSA screening with all male patients. 13 This survey was conducted in 2007-2008, before the publication of the 'new' USPSTF prostate cancer screening recommendations. The 2002 USPSTF recommendations did not recommend against screening men over the age of 75 years.…”

Section: Discussionmentioning

confidence: 99%

PSA screening: determinants of primary-care physician practice patterns

Tasian

Cooperberg

Potter

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND:The effect of practice guidelines and the European Randomised Screening for Prostate Cancer (ERSPC) and Prostate, Lung, Colorectal and Ovarian (PLCO) trials on PSA screening practices of primary-care physicians (PCPs) is unknown. METHODS:We conducted a national cross-sectional on-line survey of a random sample of 3010 PCPs from July to August 2010. Participants were queried about their knowledge of prostate cancer, PSA screening guidelines, the ERSPC and PLCO trials, and about their PSA screening practices. Factors associated with PSA screening were identified using multivariable linear regression.RESULTS: A total of 152 (5%) participants opened and 89 completed the on-line survey, yielding a response rate of 58% for those that viewed the invitation. Eighty percent of respondents correctly identified prostate cancer risk factors. In all, 51% and 64% reported that they discuss and order PSA screening for men aged 50-75 years, respectively. Fifty-four percent were most influenced by the US Preventative Services Task Force (USPSTF) guidelines. Also, 21% and 28% of respondents stated that their PSA screening practices were influenced by the ERSPC and PLCO trials, respectively. Medical specialty was the only variable associated with propensity to screen, with family medicine physicians more likely to use PSA screening than internists (b ¼ 0.21, P ¼ 0.02). CONCLUSIONS:Half of the physicians surveyed did not routinely discuss PSA screening with eligible patients. The impact of the ERSPC and PLCO trials on PSA screening practices was low among US PCPs. USPSTF recommendations for PSA screening continue to be the strongest influence on PCPs' propensity to use PSA screening.

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Discussions About Prostate Cancer Screening Between U.S. Primary Care Physicians and Their Patients

Cited by 21 publications

References 21 publications

Prostate-specific antigen screening: An update of physician beliefs and practices

Prostate-specific antigen screening: An update of physician beliefs and practices

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

PSA screening: determinants of primary-care physician practice patterns

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