Annals of Family Medicine -- Comments for McFall, 4 (5) 433-436

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Original Research:
Stephanie L. McFall
US Men Discussing Prostate-Specific Antigen Tests With a Physician
Ann Fam Med 2006; 4: 433-436 [Abstract] [Full text] [PDF]

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Electronic letters published:

PSA patient information: Be mindful how you use it: David L. Hahn (3 October 2006)

PSA patient information: Be mindful how you use it 3 October 2006

David L. Hahn,
Madison, Wisconsin, USA
Family physician
Send response to journal:
Re: PSA patient information: Be mindful how you use it

Medical organizations disagree about whether or how to recommend PSA screening for prostate cancer, but are unanimous in agreeing that, when offered, the recommendation should be accompanied by shared decision- making (1). McFall reports that such shared decision-making is apparently not taking place in over a third of screening episodes nationwide (2). One barrier to shared decision-making in the busy office setting is the extra time required to discuss complex issues surrounding preventive services involving known harm and unknown benefit, such as PSA (1, 3). In 1993, Dr. Rich Roberts and I published a patient information handout to facilitate PSA shared decision-making (3). I now offer an updated handout containing new information not available in 1993 to any practitioner wishing to engage in shared decision-making with patients (4). Although new information is available, the message remains the same: PSA screening is a potentially dangerous undertaking with no proven value in preventing morbidity or mortality.
In its critique of American medicine, the Quality Chasm Report (5), the Institute of Medicine (IOM) proposed 6 aims: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. It is not by accident that Safety leads the list. Congruent with the IOM aims, several evidence-based groups take the position that PSA screening should not be recommended absent strong evidence that effectiveness outweighs risk. Other medical organizations have taken different philosophical positions. For example, the American Urological Association and the American Cancer Society state that, after the shared decision-making process, men who cannot make up their minds should be screened. The American Academy of Family Physicians (AAFP) recommends that physicians should reach outside their office settings into the community to solicit discussions about PSA screening from every man.
I offer this updated PSA handout in the spirit of promoting shared decision-making in the context of evidence-based medical practice, with the realization that furnishing patient information per se is not sufficient to promote one of the most important aims of evidence-based medical practice: safety.
References
(1) http://www.deancare.com/healthplan_docs/ClinicalAssessments/PSAfinalCPA121305.swf (Clinical Practice Assessment of PSA Screening)
(2) McFall, S. L. 2006. US men discussing prostate-specific antigen tests with a physician. Ann Fam Med 4:433-436.
(3) Hahn, D. L., and R. G. Roberts. 1993. PSA screening for asymptomatic prostate cancer: truth in advertising. J Fam Pract 37(5):432-436.
(4) https://mywebspace.wisc.edu/xythoswfs/webui/_xy-8053927_1-t_xereO7mQ
(5) http://www.iom.edu/CMS/8089/5432.aspx (IOM Quality Chasm Report)
Competing interests: None declared