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

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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.

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Authors and Affiliations

  1. the Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH

    Ann Barry Flood PhD, John E. Wennberg MD, MPH & Jiao Ding MA, MS

  2. Laboratory for Medical Decision Sciences, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Mo.

    Robert F. Nease Jr. PhD & Lynda M. Hynes MS

  3. Center for Survey Research, University of Massachusetts, Boston

    Floyd J. Fowler Jr. PhD

Authors
  1. Ann Barry Flood PhD
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  2. John E. Wennberg MD, MPH
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  3. Robert F. Nease Jr. PhD
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  4. Floyd J. Fowler Jr. PhD
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  5. Jiao Ding MA, MS
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  6. Lynda M. Hynes MS
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where work was performed

This work was supported by the Agency for Health Care Policy and Research under the Prostate Patient Outcomes Research Team (PORT) grants, HS06336 and HS08397; RFN was supported as a Picker/Commonwealth Scholar.

The Foundation for Informed Medical Decision Making granted permission to use the PORT videotape, “The PSA Decision: What YOU Should Know: A Shared Decision Making Videotape Program,” © March 1994. PORT scientific advisers for this videotape were John H. Wasson, MD, Michael J. Barry, MD, JEW, and FJF; Gary J. Schwitzer was its producer and narrator. Schering Corporation gave permission to use the Prostate Cancer Educational Council videotape, “Prostate Cancer ’92: Some Good News Men Can Live with.” John A. Heaney, MB, BCh, Reginald C. Bruskewitz, MD, and Paul D. Gerber, MD, provided clinical advice for the studies and access to patients. Bonnie Haubrich, Scott Fan, and Suzanne Smith aided in patient identification and data retrieval; Sandra Camp and Megan McCracken conducted the telephone interviews.

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Flood, A.B., Wennberg, J.E., Nease, R.F. et al. The importance of patient preference in the decision to screen for prostate cancer. J Gen Intern Med 11, 342–349 (1996). https://doi.org/10.1007/BF02600045

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