PCPs’ opinions about PSA testing and “shared decision-making”

A report in Family Medicine gives us some insight into the views of primary care physicians (PCPs) with respect to PSA testing for prostate cancer risk and the appropriate roles of the patient and the physician in the decision to have or not have PSA tests.

Most formal guidelines on the use of PSA testing now recommend a discussion between physicians and their male patients about  the risks and benefits of “screening” of individual patients.

Davis et al. surveyed a relatively small group of primary care physicians in order to evaluate their attitudes to PSA testing and specific factors that might be important to the concept of “shared decision-making” between patient and physician about such testing.

Level of training and practice setting were considered to be an important factor in the behavior of the physicians. Participants included:

  • 16 academic clinicians
  • 84 interns and residents (i.e., physicians still in training)
  • 35 community-based practitioners

All 135 physicians completed a 26-item survey that assessed their attitudes, with the following key results:

  • 64/135 physicians (47.4 percent) endorsed shared decision making.
  • 48/135 physicians (35.6 percent) endorsed a patient decision model.
  • Few physicians wanted to decide for their patients about PSA testing.

However, interestingly:

  • 74/135 physicians (54.8 percent) considered that an annual PSA test was the standard of care.
  • Almost all physicians (126/135; 93.3 percent) believed that decisions should be based on full disclosure of the risks and benefits of testing.
  • Only about a third of the physicians (49/135; 36.6 percent) thought that the sensitivity and specificity of the PSA was adequate for use as a screening test.
  • Compared to academic clinicians and interns/residents, community clinicians were
    • More likely to endorse annual screening
    • More likely to be concerned about the threats of malpractice
    • More likely to agree that the sensitivity and specificity of the PSA test is adequate for use as a screening test.
  • Factors having the potential to influence the shared decision-making process (and cited by physicians in all three groups) included:
    • Time pressures
    • Competing health demands
    • Malpractice fears
    • Patient interest

The authors conclude that, “Further effort is needed to overcome the barriers of engaging patients in [shared decision-making]” if — as recommended in national guidelines — we really want to promote appropriate and effective dialog between physicians and patients about PSA testing for the individual patient.

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