Why do Primary Care Physicians in the United States and France Order Prostate-Specific Antigen Tests for Asymptomatic Patients?

Sorum, Paul Clay; Shim, Junseop; Chasseigne, Gérard; Bonnin-Scaon, Sylvie; Cogneau, Joël; Mullet, Étienne

doi:10.1177/0272989x03256010

Cited by 35 publications

(54 citation statements)

References 58 publications

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“…Applying the inclusion and exclusion criteria, 929 were excluded on the basis of the title and abstract (Kappa: 0.90) and 160 on the basis of the full text (Kappa: 0.95). Twenty articles were retained: 14 studies analysing the PCP's point of view [24][25][26][27][28][29][30][31][32][33][34][35][36][37] , 5 studies analysing the patient's point of view [38][39][40][41][42] , one study analysing both. 43 3.1.…”

Section: Resultsmentioning

confidence: 99%

“…In the U.S., more than 60% of PCP's were considered as "aggressive" screeners for prostate cancer 26,35 , with 61% to 88% of PCPs recommending PSA screening to healthy patients. 26,31,33,34,37 Physicians reported high and rising rates of PSA testing from 1993 to 1998. 34 The number of PCPs recommending PSA testing of healthy men is also high in Canada (87.5% 28 last year.…”

Section: Pcps' Self-reported Practicesmentioning

confidence: 99%

“…Indeed, PCPs are more likely to order PSA tests for patients who have a higher risk of prostate cancer due to a family history of prostate cancer [24][25][26][27][28][29]32,34,37 or are African-American. 26,27 PCPs are more likely to order PSA tests for patients who have low urinary track symptoms (LUTS) [24][25][26]30,32,33,43 , or an abnormal result from a digital rectal examination. 32,33 With regard to screening the elderly, five studies 25,26,31,33,35 show that PCPs support screening older men for prostate cancer: PCPs do not stop screening their elderly patients.…”

Section: Factors Influencing Psa Screening For Prostate Cancermentioning

confidence: 99%

“…26,27 PCPs are more likely to order PSA tests for patients who have low urinary track symptoms (LUTS) [24][25][26]30,32,33,43 , or an abnormal result from a digital rectal examination. 32,33 With regard to screening the elderly, five studies 25,26,31,33,35 show that PCPs support screening older men for prostate cancer: PCPs do not stop screening their elderly patients. 31 24,25,[27][28][29][32][33][34][35][36] ).…”

Section: Factors Influencing Psa Screening For Prostate Cancermentioning

confidence: 99%

“…32,33 With regard to screening the elderly, five studies 25,26,31,33,35 show that PCPs support screening older men for prostate cancer: PCPs do not stop screening their elderly patients. 31 24,25,[27][28][29][32][33][34][35][36] ). Physicians initiate screening more often than patients.…”

Section: Factors Influencing Psa Screening For Prostate Cancermentioning

confidence: 99%

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The decision-making process in prostate cancer screening in primary care with a prostate-specific antigen: A systematic review

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Journal of Geriatric Oncology

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Section: Resultsmentioning

confidence: 99%

Section: Pcps' Self-reported Practicesmentioning

confidence: 99%

Section: Factors Influencing Psa Screening For Prostate Cancermentioning

confidence: 99%

Section: Factors Influencing Psa Screening For Prostate Cancermentioning

confidence: 99%

Section: Factors Influencing Psa Screening For Prostate Cancermentioning

confidence: 99%

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The decision-making process in prostate cancer screening in primary care with a prostate-specific antigen: A systematic review

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Cardiologists' Use of Percutaneous Coronary Interventions for Stable Coronary Artery Disease

2007

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Background: Percutaneous coronary intervention (PCI) is commonly performed in patients with stable coronary artery disease, despite current evidence suggesting that such patients derive minimal benefit from the procedure. We sought to determine the influences on cardiologists' decision to perform elective PCI in patients with stable coronary artery disease. Methods: We conducted a qualitative study using 3 focus groups of interventional and noninterventional cardiologists in California. Participants discussed issues surrounding the decision to perform PCI using hypothetical case scenarios. We analyzed the data according to the principles of grounded theory. Results: Despite acknowledging data showing that PCI offers no reduction in the risk of death or myocardial infarction in patients with stable coronary artery disease, cardiologists generally believed that PCI would benefit such patients. Reasons given for performing PCI included be

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Medical Overuse as a Physician Cognitive Error

Korenstein

2019

JAMA Intern Med

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Medical overuse, or health services for which potential harms outweigh benefits, is common and persistent. Medical overuse is assumed to exist when regional variation occurs without improvements in outcomes and is believed to be driven largely by perverse financial incentives and local cultures of care. 1 In this issue of JAMA Internal Medicine, Schwartz and colleagues 2 quantified variations in primary care physician provision of low-value services (largely representing overuse) among Medicare beneficiaries and characterized associations with physician characteristics such as age, training, and research activities. Although practice varied widely within organizations, little variation was due to observable physician characteristics. These findings suggest that overuse drivers go beyond incentives and culture and that reducing overuse will require deeper understanding of physician behavior.Behavioral economics describes the following 2 modes of decision making: reflexive, intuitive processes and those that are conscious, reflective, and analytic. 3 Reflexive decisions require less cognitive effort and generally predominate; mental shortcuts, or heuristics, facilitate reflexive thought. 3 Practicing medicine involves both types of decision making. Reflexive clinical decisions may rely on unconscious pattern recognition (eg, diagnosing acne), whereas reflective decisions require complex reasoning, evidence interpretation, or nuanced communication. Common cognitive biases can lead to errors in both types of decision making, undermining analytic thinking and enabling inappropriate reflexive thinking when deeper analysis is warranted. In physicians these biases are associated with medical and diagnostic errors. 4 Medical overuse can thus be framed as a clinical cognitive error, explained by cognitive processes and biases involving suboptimal analytic thinking and erroneous intuitive decision making. Individual-level variations in overuse described by Schwartz et al 2 arise from differences in cognitive errors.Overuse resulting from cognitive errors involves problems with reflexive and reflective decisions. Although physicians may overrely on heuristics in lieu of analytic thinking, when they do engage in thoughtful consideration they are also likely to make errors that can lead to overuse. Physicians have poor numeracy and generally overestimate the benefits and underestimate the harms of tests and treatments. 5 Knowledge and understanding of medical evidence and basic risk information needed to inform diagnostic and therapeutic decisions may also be poor. Resulting errors of risk-related reasoning vary among individuals and can partly explain why some physicians order tests and treatments that represent overuse.Heuristics, cognitive biases, and other unconscious factors also vary among individuals and influence practice. Basic physician beliefs can facilitate erroneous reflective thinking and lead

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Why do Primary Care Physicians in the United States and France Order Prostate-Specific Antigen Tests for Asymptomatic Patients?

Abstract: Nonrational factors can impede physicians' adoption of "evidence-based" recommendations.

Cited by 35 publications

References 58 publications

The decision-making process in prostate cancer screening in primary care with a prostate-specific antigen: A systematic review

The decision-making process in prostate cancer screening in primary care with a prostate-specific antigen: A systematic review

Cardiologists' Use of Percutaneous Coronary Interventions for Stable Coronary Artery Disease

Medical Overuse as a Physician Cognitive Error

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