Prostate cancer screening among family physicians in Ontario: An update on attitudes and current practice

Abstract

Introduction: This study serves as an update of prostate cancer screening practices among family physicians in Ontario, Canada. Since this population was first surveyed in 2010, the Canadian Task Force on Preventive Health Care (CTFPHC) and the United States Preventive Services Task Force (USPSTF) released recommendations against prostate cancer screening. Methods: An online survey was developed through input from urologists and family practitioners. It was distributed via email to all members of the Ontario Medical Association's Section on General and Family practice (11 657 family physicians). A reminder email was sent at two weeks and the survey remained active for one month. Results: A total of 1880 family physicians completed surveys (response rate 16.1%). Overall, 80.4% offered prostate cancer screening compared to 91.7% when surveyed in 2010. Physicians new to practice (two years or less) were the most likely to not offer screening (24.6%). A combination of digital rectal exam (DRE) and prostate-specific antigen (PSA) remained the most common form of screening (58.3%). Following the release of the CTFPHC recommendations, 45.6% of respondents said they now screen fewer patients. Participants were less familiar with national urological society guidelines compared to task force recommendations. The majority (72.6%) of respondents feel PSA screening leads to overdiagnosis and treatment. Those surveyed remained split with respect to PSA utility. Conclusions: Data suggest a decline in screening practices since 2010, with newer graduates less likely to offer screening. CFTPHC and USPSTF recommendations had the greatest impact on clinical practice. Those surveyed were divided with respect to PSA utility. Some additional considerations to PSA screening in the primary care setting, including patient-driven factors, were not captured by our concise survey.

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

“…An example of the positive impact of guidelines in reducing overuse has been with prostate cancer screening. [72] Conversely, clinicians may order tests that are not clinically indicated because policies mandate it. [29] Guidelines are considered a reputable source of evidence based recommendations to support clinical decision making.…”

“…Interpretations and attitudes toward guidelines, protocols and policies were found to signi cantly in uence test ordering behaviour in 21 articles. Akerman et al [72] found that that there was a drop in prostate screening rates from 91.7-80.4% when new recommendations from the Canadian and United States Preventive Services Task Force were released following evidence of little net bene t from screening. A number of studies showed that non-existent or discordant guidelines can result in overtesting.…”

Why clinicians overtest: development of a thematic framework

“…But how must I say "you have to accept it" if the neurologist says that perhaps the patient should be looked at by someone else" [46] "If I get a letter from the diagnostic centre with the comment "You request 10% more than the average GP in Maastricht", then you get critical. You wonder if we should wait a bit longer with this patient" [46] "If you're not going to order it, the next doctor will" [59] "Environment/context factors" affecting clinician test ordering behaviour, with number of articles and quotes from [33,36,37,45,47,49,50,[53][54][55][56][57][58][59][60]62,64,66,72,73,87] "There are situations where I've ordered an echo when I otherwise would not have because guidelines mandated" [37] "I think there's more, as much as we've developed these decision rules-I think there's a lot to be said about just experience" [47] "I think people are wary of practicing not in line with that and then they have potential then for criticism" [60] "There's plenty of guidelines, but they're all different and there's nothing official...there's no hard and fast rule" [60] "Because I work in a teaching practice, my residents are very devoted to guidelines. A lot of them are driven by the more recent guidelines" [66] ancial ives and hip of tests 21 articles [1,2,7,15,21,23,[36][37][38]…”

Why clinicians overtest: development of a thematic framework

“…Interpretations and attitudes toward guidelines, protocols and policies were found to signi cantly in uence test ordering behaviour in 21 articles. Akerman et al [54] found that that there was a drop in prostate screening rates from 91.7% to 80.4% when new recommendations from the Canadian and United States Preventive Services Task Force were released following evidence of little net bene t from screening. A number of studies showed that non-existent or discordant guidelines can result in overtesting.…”