Experts Report That Recommendations for PSA Screening is guided by Doctor’s Belief

January 15, 2013 by  
Filed under Prostate Cancer News

The belief of the doctor on the benefits of the PSA screening for prostate cancer can lead to the decision of recommending the test for the patient.

In other words, the belief of the doctors on the risks and benefits of screening and how it can help patients affects recommendations.

A study by researchers from the University of Texas and published in the “Annals of Family Medicine” have highlighted the above fact.

Here are more details as published online by Medscape’s Norra MacReady on January 14, 2013:

When it comes to discussing the risks and benefits of screening for prostate cancer and helping patients decide whether screening is right for them, primary care physicians vary widely in their approaches, a new study shows.

Much of this variability was associated with the different physicians’ beliefs about the value of routine screening, according to Robert J. Volk, PhD, from the Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, and colleagues. “[S]ome of these beliefs may be amenable to change,” the authors write, in an article published in the January/February issue of the Annals of Family Medicine.

Dr. Volk and colleagues sent questionnaires via postal mail or email to 426 members of the American Academy of Family Physicians National Research Network between January 2007 and July 2008, . Network members participate in research designed to describe and improve primary care practice.

The researchers asked physicians which approach to prostate cancer screening was closest to their own: screening without discussion (ordering the prostate-specific antigen [PSA] test without discussing it with the patient), recommending screening after first discussing the harms and benefits, letting the patient decide after a discussion of the harms and benefits, recommending against screening after discussing the harms and benefits, or foregoing the test and any discussion of its harms and benefits.

They also asked physicians about their beliefs regarding the value of PSA screening, asking them to rate their agreement with each of a series of statements on a scale of 1 (strongly disagree) to 5 (strongly agree). Sample belief indicators include: “The benefits of prostate cancer screening outweigh the risks”; “There is clear evidence that prostate cancer screening saves lives”; and “Patients have a right to know the implications of prostate cancer screening before they are screened”.

Of the 426 physicians contacted, 246 (57.7%) responded. Three did not answer the questions about their approach to PSA screening, so their surveys were excluded from the analysis. Of the remaining 243 participants, 116 (47.7%) said they let the patient decide whether or not to undergo screening after a discussion of the risks and benefits. Fifty-nine (24.3%) ordered the test without discussion, and 55 (22.6%) recommended the test after a discussion with the patient. The remaining 5% of physicians discussed the test and then either recommended against it or neither discussed nor recommended screening.

The analysis of belief indicators included only physicians in the first 3 groups (n = 230). In a multinomial logistic regression model, the authors adjusted for years in practice, physician sex, and whether the practice was academically affiliated.

Only 20.3% of physicians who ordered screening without discussion believed that the evidence does not support routine testing compared with 23.6% of physicians who recommended the test and 71.6% who let their patients decide (P < .001). Of physicians who ordered the test without discussion, 35.6% believed patients should be informed of this lack of evidence compared with 61.8% of physicians who recommended the test and 90.5% of those who let the patients decide (P < .001). The investigators saw similar differences among physicians who believed that patients have a right to know the implications of screening (52.5%, 92.7%, and 98.3%, respectively; P < .001).

In a finding the authors describe as “provocative,” 87.3% of physicians who recommended the test after a discussion of its risks and benefits cited concerns about medicolegal risks associated with not screening compared with 76.3% of physicians who ordered the test without discussing it with the patient and 63.8% of those who let the patient decide (P = .004). This concern may affect PSA testing rates, the authors say.

Decision aids that the patient can study before the actual clinical encounter may allow him to feel more prepared to make decisions while taking some of the burden off time-strapped physicians, the authors write. For physicians worried about malpractice issues, use of these aids as part of a larger, shared decision-making process in which the patient is adequately informed of the risks and benefits of PSA screening may satisfy medicolegal requirements.

“Currently, there are few negative sequelae for physicians who routinely screen patients for prostate cancer” the authors conclude. “Efforts to educate physicians about the shared decision-making process should include countering the beliefs that perpetuate routine screening.” Source.

Conclusively, routine screening is a matter of the belief of the doctor as the above study has highlighted.

However, this does not take away the fact that men should play significant role in making screening decision for their condition.

It is therefore very important that adequate information is made available so that men understand the risks and benefits going for the PSA tests.

More details on the above study can be accessed from the January/February issue of the Annals of Family Medicine.

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