Do PCPs actually hold pre-testing discussions with patients about prostate cancer risk?

Even though many medical organizations recommend discussions between patients and their doctors before testing of individuals for risk of prostate cancer, there are few hard data about how primary care physicians (PCPs) actually apply thee guidelines to promote informed decision making for prostate cancer testing.

Linder et al. have conducted a small study to investigate the application of pre-testing discussions by PCPs, and the reasons why PCPs would or would not try to persuade patients to be tested if they initially refused such tests.

The core results of their study can be summarized as follows:

  • 66/87 PCPs invited to participate completed a self-administered survey about prostate cancer testing practices for informed decision making and 63 of these surveys were used in the analysis.
  • 13/63 physicians (20.6 percent) reported not using pre-testing discussions at all.
  • 45/63 physicians (71.4 percent) reported the use of pre-testing discussions.
  • 3/63 physicians (4.8 percent) reported neither ordering the PSA test nor discussing it with patients.
  • 9/13 physicians (69 percent) who reported not having discussions indicated they were more likely to test African American patients for prostate cancer, compared to 50 percent of physicians who reported the use of discussions.
  • 12/13 physicians (91 percent) who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46 percent of those who reported the use of discussion.
  • Beliefs about the scientific evidence and efficacy of prostate cancer screening, ethical concerns regarding patient autonomy, and concerns about time constraints differed between physicians who would and would not try to persuade a patient to be tested.

The data collected by Linder and colleagues should be considered as a pilot study, and possibly hypothesis generating. Although professional guidelines recommend discussing the risks and benefits of prostate cancer testing, there are clearly variations in practice styles. This comes as little surprise. The “New” prostate Cancer InfoLink suggests that it is, in fact, promising that as many as 70 percent of PCPs state that they do have pre-testing conversations with their patients (although the quality of those discussions may be open to question).

The issue that we need to be considering is a two-part question:

  • Is it possible to develop standardized guidance for PCPs that will optimize the likelihood of early diagnosis of clinically significant prostate cancer among those who need to be diagnosed?
  • Should we be developing standardized informational tools for physicians to use with their patients that will be accceptable to most parties to this discussion?

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