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

Abstract

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mettlin CG, Johns HA, Gusberg SB, Murphy GP. Defining and updating the American Cancer Society guidelines for the cancer-related checkup: prostate and endometrial cancers. CA Cancer J Clin. 1993;43:42–7.PubMedGoogle Scholar
  2. 2.
    Catalona W, Richie JP, Ahmann FR, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol. 1994;151:1283–90.PubMedGoogle Scholar
  3. 3.
    Kramer B, Brown ML, Prorok PC, Potosky AL, Gohagan JK. Prostate cancer screening: what we know and what we need to know. Ann Intern Med. 1993;119:914–49.PubMedGoogle Scholar
  4. 4.
    U.S. Preventative Services Task Force. Screening for prostate cancer: commentary on the recommendations on the Canadian Task Force on the Periodic Health Examination. Am J Med. 1994;10:187–93.Google Scholar
  5. 5.
    Canadian Task Force on the Periodic Health Examination. Periodic health examination 1991 update 3. Secondary prevention of prostate cancer. Can Med Assoc J. 1991;145:413–28.Google Scholar
  6. 6.
    Canadian Cancer Society and Institute for Clinical Evaluative Sciences. The info on prostate cancer and the PSA: no two men are the same. Ontario: Canadian Cancer Society; July 1995.Google Scholar
  7. 7.
    Canadian Urological Association. PSA guidelines: CUA changes it’s position. CUA Newsletter 1995.Google Scholar
  8. 8.
    Handley MR, Stuart ME. The use of prostate specific antigen for prostate cancer screening: a managed care perspective. J Urol. 1994;152:1689–92.PubMedGoogle Scholar
  9. 9.
    Schroder FA. Detection of prostate cancer: screening the whole population has not yet been shown to be worth while. BMJ. 1995;310:140–1.PubMedGoogle Scholar
  10. 10.
    Schmid H, McNeal JE, Stamey TA. Observations on the doubling time of prostate cancer: the use of serial prostate-specific antigen in patients with untreated disease as a measure of increasing cancer volume. Cancer. 1993;71:2031–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Stamey T, Frieha FS, McNeal JE, et al. Localized prostate cancer: relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer. 1993;71:933–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Johansson JE, Adami HO, Andersson SO, Bergstrom R, Homberg L, Krusemo U. High 10-year survival rate in patients with early, untreated prostatic cancer. JAMA. 1992;267:2191–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Johansson JE. Watchful waiting for early stage prostate cancer. Urol. 1994;43:138–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Wasson JH, Cushman CC, Bruskewitz RC, Littenberg B, Mulley AG, Wennberg JE, and the Prostate Disease PORT. A structured literature review of treatment for localized prostate cancer. Arch Fam Med. 1993;2:487–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Fowler FJ, Barry MJ, Lu-Yao GL, Roman A, Wasson JH, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy: the national Medicare experience: 1988–1990. Urology. 1993;42:622–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Monda J. Barry M, Oesterling J. Prostate-specific antigen cannot distinguish stage Tla (Al) prostate cancer from benign prostatic hyperplasia. J Urol. 1994;151:1291–5.PubMedGoogle Scholar
  17. 17.
    Sershon P, Barry M, Oesterling J. Serum prostate-specific antigen discriminates weakly between men with benign prostatic hyperplasia and patients with organ-confined prostate cancer. Eur Urol. 1994;25:281–7.PubMedGoogle Scholar
  18. 18.
    Kassirer J. Incorporating patients’ preferences into medical decisions. N Engl J Med. 1994;330:1895–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Chodak G. Screening for prostate cancer: the debate continues. JAMA. 1994;272:813–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Wasson JH, Reda DJ, Bruskewitz RC, for the Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. N Engl J Med. 1995;32:75–9.CrossRefGoogle Scholar
  21. 21.
    Black W, Nease RF Jr, Tosteson ANA. Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst. 1995;87(10):720–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Lerman C, Rimer B. Effects of individualized breast cancer risk counseling; a randomized trial. J Natl Cancer Inst. 1995;87(4):286–92.PubMedCrossRefGoogle Scholar

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

Personalised recommendations