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

The Article in Brief

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

Robert J. Volk , and colleagues

Background Although most primary care physicians screen for prostate cancer, little is known about their use of advance discussions of the risks and benefits of screening, a key component of an informed decision-making process. This study examines the use of prescreening discussions about the potential benefits and harms of prostate cancer screening and explores the role of physicians' beliefs about the efficacy of prostate cancer screening.

What This Study Found There is considerable variability in primary care physicians' approaches to engaging patients in advance discussions about prostate cancer screening. Much of the variability in styles can be attributed to physicians' personal beliefs about prostate cancer screening, some of which may be amenable to change. Compared with physicians who order screening without discussion (24 percent), physicians who discuss harms and benefits with patients and then let them decide (48 percent) are more likely to believe 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 are also less likely to endorse the belief that there is no need to educate patients because they want to be screened. In this study, physicians who discussed the harms and benefits and recommended the test more often expressed concerns about the legal risk associated with not screening compared with physicians who discuss and let the patient decide.

Implications

• The authors call for the use of patient decision aids and efforts to educate physicians about the shared decision-making process, including countering the false beliefs that perpetuate routine screening.