Are Physicians Discussing Prostate Cancer Screening with Their Patients and Why or Why Not? A Pilot Study
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Prostate cancer screening (PCS) is controversial. Ideally, patients should understand the risks and benefits of screening before undergoing PSA testing. This study assessed whether primary care physicians routinely discuss PCS and explored the barriers to and facilitators of these discussions.
Qualitative pilot study involving in-depth, semistructured interviews with 18 purposively sampled, academic and community-based primary care physicians. Barriers and facilitators of PCS discussions were ascertained using both interviews and chart-stimulated recall—a technique utilizing patient charts to probe recall and provide context to physician decision-making during clinic encounters. Analysis was performed using consensus conferences based on grounded theory techniques.
All 18 participating physicians reported that they generally discussed PCS with patients, though 6 reported sometimes ordering PSA tests without discussion. A PCS discussion occurred in only 16 (36%) of the 44 patient–physician encounters when patients were due for PCS that also met criteria for chart-stimulated recall. Barriers to PCS discussion were patient comorbidity, limited education/health literacy, prior refusal of care, physician forgetfulness, acute-care visits, and lack of time. Facilitators of PCS discussion included patient-requested screening, highly educated patients, family history of prostate cancer, African-American race, visits for routine physicals, review of previous PSA results, extra time during encounters, and reminder systems.
PCS discussions sometimes do not occur. Important barriers to discussion are inadequate time for health maintenance, physician forgetfulness, and patient characteristics. Future research should explore using educational and decision support interventions to involve more patients in PCS decisions.
KEY WORDSprostate-specific antigen prostate cancer screening mass screening physician practice patterns physician–patient relations communication barriers informed decision making
The authors gratefully acknowledge the grant support from the National Institutes of Health Center for Population Health and Health Disparities at the University of Pennsylvania (Public Health Service Grant P50-CA105641) as well as the participating physicians for sharing their valuable perspectives. Dr. Guerra also acknowledges the National Cancer Institute (Public Health Service Grant K01 CA97925) and the Robert Wood Johnson Foundation (fund number 051895) for their additional grant support. The results of this paper were previously presented at the 28th Annual Meeting of the Society of General Internal Medicine, May 12, 2005, New Orleans, LA, USA.
Conflict of Interest
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