Journal of General Internal Medicine

, Volume 26, Issue 10, pp 1098–1104

Discussions About Prostate Cancer Screening Between U.S. Primary Care Physicians and Their Patients

  • Ingrid J. Hall
  • Yhenneko J. Taylor
  • Louie E. Ross
  • Lisa C. Richardson
  • Thomas B. Richards
  • Sun Hee Rim
Original Research

Abstract

Objective

This study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior.

Methods

We analyzed data from the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression.

Results

Eighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31–40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice.

Conclusions

Both individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S.

KEY WORDS

primary care physicians prostate cancer screening prostate-specific antigen physician–patient discussions prostate cancer 

Supplementary material

11606_2011_1682_MOESM1_ESM.doc (63 kb)
ESM 1(DOC 63 kb)

References

  1. 1.
    Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010;60:70–98.PubMedCrossRefGoogle Scholar
  2. 2.
    Voss JD, Schectman JM. Prostate cancer screening practices and beliefs. J Gen Intern Med. 2001;16:831–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Ross LE, Taylor YJ, Richardson LC, Howard DL. Patterns in prostate-specific antigen test use and digital rectal examinations in the Behavioral Risk Factor Surveillance System, 2002–2006. J Natl Med Assoc. 2009;101:316–24.PubMedGoogle Scholar
  4. 4.
    Swan J, Breen N, Graubard BI, McNeel TS, Blackman D, Tangka FK, Ballard-Barbash R. Data and trends in cancer screening in the United States: Results from the 2005 National Health Interview Survey. Cancer. 2010;116:4872–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Ross LE. Zahava Berkowitz Z, Donatus U. Ekwueme DU. Use of the Prostate-Specific Antigen Test among U.S. Men: Findings from the 2005 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2008;17(3):636–44.CrossRefGoogle Scholar
  6. 6.
    National Guideline Clearinghouse. Guideline synthesis: screening for prostate cancer. Available at: http://www.guideline.gov. Accessed February 15, 2011.
  7. 7.
    Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2009;59:27–41.PubMedCrossRefGoogle Scholar
  8. 8.
    Lim LS, Sherin K. Screening for prostate cancer in U.S. men ACPM position statement on preventive practice. Am J Prev Med. 2008;34:164–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Guerra CE, Jacobs SE, Holmes JH, Shea JA. Are physicians discussing prostate cancer screening with their patients and why or why not? A pilot study. J Gen Intern Med. 2007;22:901–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Linder SK, Hawley ST, Cooper CP, Scholl LE, Jibaja-Weiss M, Volk RJ. Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey. BMC Fam Pract. 2009;10:1–6.CrossRefGoogle Scholar
  11. 11.
    Han PK, Coates RJ, Uhler RJ, Breen N. Decision making in prostate-specific antigen screening: National Health Interview Survey, 2000. Am J Prev Med. 2006;30:394–404.PubMedCrossRefGoogle Scholar
  12. 12.
    McFall SL. US men discussing prostate-specific antigen tests with a physician. Ann Fam Med. 2006;4:433–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Tannor BB, Ross LE. Physician–patient discussions about prostate-specific antigen test use among African-American men. J Natl Med Assoc. 2006;98:532–8.PubMedGoogle Scholar
  14. 14.
    Dunn AS, Shridharani KV, Lou W, Bernstein J, Horowitz CR. Physician–patient discussions of controversial cancer screening tests. Am J Prev Med. 2001;20:130–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Wolf AM, Becker DM. Cancer screening and informed patient discussions. Truth and consequences. Arch Intern Med. 1996;156:1069–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Pendleton J, Curry RW, Kaserian A, et al. Knowledge and attitudes of primary care physicians regarding prostate cancer screening. J Natl Med Assoc. 2008;100:666–70.PubMedGoogle Scholar
  17. 17.
    Cooper CP, Merritt TL, Ross LE, John LV, Jorgensen CM. To screen or not to screen, when clinical guidelines disagree: primary care physicians' use of the PSA test. Prev Med. 2004;38:182–191.CrossRefGoogle Scholar
  18. 18.
    Stroud LA, Ross LE, Rose SW. Formative evaluation of the prostate cancer screening practices of African-American physicians. J Natl Med Assoc. 2006;98:1637–43.PubMedGoogle Scholar
  19. 19.
    Hoffman RM, Couper MP, Zikmund-Fisher BJ, et al. Prostate cancer screening decisions: results from the National Survey of Medical Decisions (DECISIONS study). Arch Intern Med. 2009;169:1611–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Drummond FJ, Sharp L, Comber H. Major inter-laboratory variations in PSA testing practices: results from national surveys in Ireland in 2006 and 2007. Ir J Med Sci. 2008;177:317–23.PubMedCrossRefGoogle Scholar
  21. 21.
    Jordan TR, Price JH, King KA, Masyk T, Bedell AW. The validity of male patients' self-reports regarding prostate cancer screening. Prev Med. 1999;28:297–303.PubMedCrossRefGoogle Scholar
  22. 22.
    Volk RJ, Cass AR. The accuracy of primary care patients' self-reports of prostate-specific antigen testing. Am J Prev Med. 2002;22:56–8.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Ingrid J. Hall
    • 1
  • Yhenneko J. Taylor
    • 2
  • Louie E. Ross
    • 3
  • Lisa C. Richardson
    • 1
  • Thomas B. Richards
    • 1
  • Sun Hee Rim
    • 1
  1. 1.Division of Cancer Prevention and Control, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Department of Public Health SciencesUniversity of North Carolina at CharlotteCharlotteUSA
  3. 3.Ross-Holmes Group LLCRaleighUSA

Personalised recommendations