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Annals of Family Medicine 5:120-125 (2007)
© 2007 Annals of Family Medicine, Inc.

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How Physicians Approach Prostate Cancer Screening Before and After Losing a Lawsuit

Alex H. Krist, MD, MPH1, Steven H. Woolf, MD, MPH2 and Robert E. Johnson, PhD3

1 Department of Family Medicine, Fairfax Family Practice Residency, Virginia Commonwealth University, Fairfax, Va
2 Departments of Family Medicine, Epidemiology, and Community Health, Virginia Commonwealth University, Fairfax, Va
3 Departments of Family Medicine and Biostatistics, Virginia Commonwealth University, Fairfax, Va


Figure 1
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  		Figure 1. Patient-reported locus of decision-making control in relation to the Merenstein case (N = 431 question respondents).

Note: The figure shows patients’ responses to the survey question, "How was the decision made today on whether to do a PSA blood test? (A) I made the decision on whether to order a PSA test. (B) I made the decision about whether to order a PSA test after seriously considering my doctor’s opinion. (C) My doctor and I shared the responsibility for deciding whether to order a PSA test. (D) My doctor made the final decision about whether to order a PSA test after seriously considering my opinion. (E) My doctor made the decision whether to order a PSA test." Before period = January 2002 through June 2003; diffusion period = July 2003 through December 2003; after period = January 2004 through November 2004. The differences across the 3 time periods are not significant (P = .54).

 

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  		Figure 2. Patient-reported elements of the prostate cancer screening discussion in relation to the Merenstein case (N = 432).

PSA = prostate-specific antigen.

Note: The figure shows temporal trends of measured elements of the prostate cancer screening process in relation to the Merenstein case (before, diffusion, and after periods) as reported by 432 patients who returned a completed questionnaire. The left-hand axis and black lines represent an ordinal scale from 1 to 10. The right-hand axis and gray lines represent a percentage scale from 0% to 100%. Comparing the before and after time periods, the differences are not significant for decisional conflict (P = .23), number of topics discussed (P = .37), time spent on discussion (P = .20), and knowledge (P = .86). The percentage of patients receiving a PSA test increased, however (84% vs 90%; P = .03).

 




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