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Research ArticleOriginal Research

Primary Care Physicians’ Use of an Informed Decision-Making Process for Prostate Cancer Screening

Robert J. Volk, Suzanne K. Linder, Michael A. Kallen, James M. Galliher, Mindy S. Spano, Patricia Dolan Mullen and Stephen J. Spann
The Annals of Family Medicine January 2013, 11 (1) 67-74; DOI: https://doi.org/10.1370/afm.1445
Robert J. Volk
1Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
PhD
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  • For correspondence: bvolk@mdanderson.org
Suzanne K. Linder
1Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
PhD
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Michael A. Kallen
2Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
PhDMPH
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James M. Galliher
3American Academy of Family Physicians National Research Network; Department of Sociology, University of Missouri–Kansas City, Kansas City, Missouri
4Department of Family Medicine, University of Colorado Health Sciences Center at Denver, Denver, Colorado
PhD
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Mindy S. Spano
3American Academy of Family Physicians National Research Network; Department of Sociology, University of Missouri–Kansas City, Kansas City, Missouri
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Patricia Dolan Mullen
5Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, Texas
DrPH
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Stephen J. Spann
6Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
MDMBA
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Abstract

PURPOSE Leading professional organizations acknowledge the importance of an informed decision-making process for prostate cancer screening. We describe primary care physicians’ reports of their prescreening discussions about the potential harms and benefits of prostate cancer screening.

METHODS Members of the American Academy of Family Physicians National Research Network responded to a survey that included (1) an indicator of practice styles related to discussing harms and benefits of prostate-specific antigen testing and providing a screening recommendation or letting patients decide, and (2) indicators reflecting physicians’ beliefs about prostate cancer screening. The survey was conducted between July 2007 and January 2008.

RESULTS Of 426 physicians 246 (57.7%) completed the survey questionnaire. Compared with physicians who ordered screening without discussion (24.3%), physicians who discussed harms and benefits with patients and then let them decide (47.7%) 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; they were also less likely to endorse the belief that there was no need to educate patients because they wanted to be screened. Concerns about medicolegal risk associated with not screening were more common among physicians who discussed the harms and benefits and recommended screening than among physicians who discussed screening and let their patients decide.

CONCLUSIONS Much of the variability in physicians’ use of an informed decision-making process can be attributed to beliefs about screening. Concerns about medicolegal risk remain an important barrier for shared decision making.

Key words
  • prostatic neoplasms
  • decision making
  • physicians
  • primary care
  • early detection of cancer
  • Received for publication December 29, 2011.
  • Revision received May 25, 2012.
  • Accepted for publication July 17, 2012.
  • © 2013 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 11 (1)
The Annals of Family Medicine: 11 (1)
Vol. 11, Issue 1
January/February 2013
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Primary Care Physicians’ Use of an Informed Decision-Making Process for Prostate Cancer Screening
Robert J. Volk, Suzanne K. Linder, Michael A. Kallen, James M. Galliher, Mindy S. Spano, Patricia Dolan Mullen, Stephen J. Spann
The Annals of Family Medicine Jan 2013, 11 (1) 67-74; DOI: 10.1370/afm.1445

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Primary Care Physicians’ Use of an Informed Decision-Making Process for Prostate Cancer Screening
Robert J. Volk, Suzanne K. Linder, Michael A. Kallen, James M. Galliher, Mindy S. Spano, Patricia Dolan Mullen, Stephen J. Spann
The Annals of Family Medicine Jan 2013, 11 (1) 67-74; DOI: 10.1370/afm.1445
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Subjects

  • Domains of illness & health:
    • Prevention
  • Person groups:
    • Older adults
  • Methods:
    • Quantitative methods
  • Other research types:
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  • Other topics:
    • Communication / decision making

Keywords

  • prostatic neoplasms
  • decision making
  • physicians
  • primary care
  • early detection of cancer

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