Primary-care practitioner beliefs about prostate-cancer screening account for much of the variability in the use of an informed-decision-making process by these providers.1
A nationwide survey completed by 246 family physicians between July 2007 and January 2008 compared physicians who ordered screening without first discussing the potential harms and benefits with the patient (24.3% of respondents) with physicians who did hold such discussions and who subsequently let the man decide whether he wanted the test (47.7% of respondents).
Members of the latter group were more likely to endorse beliefs that scientific evidence does not support screening, that patients should be told about the lack of evidence and that patients have a right to know the limitations of screening. These providers were also less likely to support the belief that a patient who wanted to be screened did not need to be educated about the test’s harms and benefits.
Among the physicians who did discuss the harms and benefits of prostate-cancer screening with patients, the providers who then recommended such testing were more likely to be concerned about the medicolegal risks associated with not screening than were physicians who let the patient decide.
The screening decision might be helped by the findings of a recent computer model of 35 screening strategies that varied by start and stop ages, screening intervals and thresholds for biopsy referral (Ann Intern Med. 2013;158:145-153).2
The model demonstrated that compared with standard screening, prostate-specific antigen (PSA) screening strategies that use higher thresholds for biopsy referral for older men and that screen men with low PSA levels less frequently can reduce harms while preserving lives.