Journal of General Internal Medicine

, Volume 11, Issue 6, pp 342–349 | Cite as

The importance of patient preference in the decision to screen for prostate cancer

  • Ann Barry Flood
  • John E. Wennberg
  • Robert F. NeaseJr.
  • Floyd J. FowlerJr.
  • Jiao Ding
  • Lynda M. Hynes
  • Members of the Prostate Patient Outcomes Research Team
Original Articles


OBJECTIVE: Routine screening for prostate cancer is controversial because of frequent false-positive results, the potential for slow, non-life-threatening growth of untreated cancer, the uncertainty regarding whether treatment can extend life, and the potential for treatment complications. This study examines how information about prostate-specific antigen (PSA) testing and the uncertain benefits of treating prostate cancer affects patients’ desire for PSA testing.

DESIGN: An educational videotape designed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was presented to two groups of male patients 50 years of age or older.

SETTING: Dartmouth-Hitchcock Medical Center.

PATIENTS/PARTICIPANTS: For study 1, men seeking a free prostate cancer screening were preassigned to view the educational videotape (N=184) or another videotape (N=188). For study 2, men scheduled to visit a general internal medicine clinic viewed either the educational videotape (N=103) or no videotape (N=93).

MEASUREMENTS AND MAIN RESULTS: The men’s information and preferences about prostate cancer screening and treatment and actual choice of PSA test at the next test opportunity were measured. Men who viewed the educational videotape were: better informed about PSA tests, prostate cancer, and its treatment; preferred no active treatment if cancer were found; and preferred not to be screened (all significant atp≤.002 in both studies). Men viewing the educational video were less likely to have a PSA test (p=.041, study 2). This tendency was not significant at the free-PSA clinic (p=.079).

CONCLUSIONS: Preference regarding cancer screening and treatment is greatly affected by information about medical uncertainties. Because informed patient choices vary, PSA screening decisions should incorporate individual preferences.

Key words

patient preference screening test medical decision making prostate cancer 


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Copyright information

© Society of General Internal Medicine 1996

Authors and Affiliations

  • Ann Barry Flood
    • 1
  • John E. Wennberg
    • 1
  • Robert F. NeaseJr.
    • 2
  • Floyd J. FowlerJr.
    • 3
  • Jiao Ding
    • 1
  • Lynda M. Hynes
    • 2
  • Members of the Prostate Patient Outcomes Research Team
  1. 1.the Center for the Evaluative Clinical Sciences, Department of Community and Family MedicineDartmouth Medical SchoolHanover
  2. 2.Laboratory for Medical Decision Sciences, Division of General Medical SciencesWashington University School of MedicineSt. Louis
  3. 3.Center for Survey ResearchUniversity of MassachusettsBoston

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