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Research ArticleOriginal Research

Physician Communication Regarding Prostate Cancer Screening: Analysis of Unannounced Standardized Patient Visits

Bo Feng, Malathi Srinivasan, Jerome R. Hoffman, Julie A. Rainwater, Erin Griffin, Marko Dragojevic, Frank C. Day and Michael S. Wilkes
The Annals of Family Medicine July 2013, 11 (4) 315-323; DOI: https://doi.org/10.1370/afm.1509
Bo Feng
1Department of Communication, University of California, Davis, Davis, California
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  • For correspondence: bfeng@ucdavis.edu
Malathi Srinivasan
2Department of Medicine, University of California, Davis, Davis, California
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Jerome R. Hoffman
3Professor of Emergency Medicine, University of Southern California, Los Angeles, California
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Julie A. Rainwater
4Clinical and Translational Science Center, University of California, Davis, Davis, California
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Erin Griffin
4Clinical and Translational Science Center, University of California, Davis, Davis, California
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Marko Dragojevic
5Department of Communication, University of California, Santa Barbara, Santa Barbara, California
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Frank C. Day
6School of Medicine, University of California, Los Angeles, Los Angeles, California
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Michael S. Wilkes
7Office of the Dean, School of Medicine, University of California, Davis, Davis, California
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    Figure 1

    Randomization scheme and participation flow of an intervention to improve shared decision making during prostate cancer screening discussions by primary care physicians, as-treated transcript analysis.

Tables

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    Table 1

    Primary Care Physician Behaviors in Provision of Information Around Prostate Cancer or Prostate Cancer Screening: 16 Coded Items

    Provision of InformationOverall (N=118) %Control (n=57) %Intervention (n=61) %
    Discusses incidence or prevalence of prostate cancer444641
    Discusses risk factors for prostate cancer453753
    Discusses natural history of prostate cancer535154
    Discusses mortality of prostate cancer615369
    Discusses controversies of PCS493960
    Discusses benefits of PSA testing878887
    Discusses problems with accuracy of PCS918893
    Discusses other drawbacks of PSA testinga706080
    Mentions no screening as an alternativea452663
    Mentions rectal examination as an alternative879383
    Discusses benefits of rectal examination586354
    Discusses drawbacks of rectal examination343236
    Discusses benefits of watchful waiting/no screening312141
    Discusses drawbacks of watchful waiting/no screening313230
    Informs next steps after abnormal PSA test787085
    Informs next steps after normal PSA test242622
    • PCS=prostate cancer screening; PSA=prostate-specific antigen.

    • Note: Percentage of physicians who provided information about prostate cancer or prostate cancer screening at least once during an unannounced standardized patient visit.

    • ↵a P <.05.

    • View popup
    Table 2

    Primary Care Physician Behaviors in Eliciting Patients’ Perspectives About Prostate Cancer or Prostate Cancer Screening: 12 Coded Items

    Elicitation of Patient PerspectivesOverall (N=118) %Control (n=57) %Intervention (n=61) %
    Asks about patient’s direct previous experience465340
    Ask about patient’s family history474054
    Asks about patient’s indirect personal experiencea8215
    Asks about patient’s knowledge305
    Asks about patient’s concerns about having PCAa7212
    Solicits concerns about having side effects from test or treatmenta307
    Offers opportunities to ask questions131213
    Checks patient’s understanding of information251930
    Explains why shared decision making is necessary for PCS282134
    Elicits patient’s preferred level of involvement in decisions000
    Assesses patient’s preferences for receipt of information000
    Asks patient his decision342839
    • PCS=prostate cancer screening; PSA=prostate-specific antigen.

    • Note: Percentage of physicians who inquired about their patient’s perspective about prostate cancer or prostate cancer screening at least once during an unannounced standardized patient visit.

    • ↵a P <.05.

    • View popup
    Table 3

    Primary Care Physicians Behaviors in Guiding Patient in Final Decision Making Around Prostate Cancer Screening: 4 Coded Items

    Guiding Final DecisionOverall (N=118) %Control (n=57) %Intervention (n=61) %
    Indicates that decisions should be based on patient’s valuesa191128
    Tells patient to think about optionsa513962
    Encourages patient to seek input from othersa16725
    Offers to provide additional informationa271836
    • Note: Percentage of physicians who provided guidance for final decision making regarding prostate cancer screening, at least once during an unannounced standardized patient visit.

    • ↵a P <.05.

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    Table 4

    Summary of Primary Care Physician Behaviors in Shared Decision Making Regarding Prostate Cancer or Prostate Cancer Screening

    BehaviorRangeOverall (N=118) Mean No.Control (n=57) Mean No.Intervention (n=61) Mean No.
    Overall shared decision making–PCS scorea0–3212.210.713.5
    Provision of information scale0–168.98.29.5
    Elicitation of patient’s perspectives scale0–122.11.82.5
    Guiding decision-making scalea0–41.10.71.5
    • PCS=prostate cancer screening.

    • Note: Each item in the scale was given a value of 0 = did not occur, or 1 = occurred.

    • ↵a P <.05.

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    Table 5

    Summary of Physician Final Clinical Recommendations After Prompting by Unannounced Standardized Patient

    RecommendationOverall (N=118) %Control (n=57) %Intervention (n=61) %
    Recommended in favor of PCS596849
    Recommended against PCS161121
    Made no recommendation252130
    Physician stated that he or she would order a PSA blood testa456031
    • PCS=prostate cancer screening; PSA=prostate-specific antigen.

    • ↵a P <.01.

Additional Files

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  • The Article in Brief

    Physician Communication Regarding Prostate Cancer Screening: Analysis of Unannounced Standardized Patient Visits

    Bo Feng , and colleagues

    Background This study is part of a randomized controlled trial to educate physicians using an interactive Web-based module on prostate cancer screening. The current analysis explores how physicians approach discussions of risk and uncertainty around prostate cancer screening.

    What This Study Found A Web-based educational intervention appears to improve shared decision making, encourage neutrality in recommendations, and reduce prostate-specific antigen (PSA) test ordering. Based on visits with 118 participating primary care physicians in which trained actors (standardized patients) prompt physicians to address prostate cancer screening, intervention physicians show more shared decision making behaviors and were more likely to mention the option of no screening, to encourage patients to consider different screening options, and to seek input from others.

    Implications

    • The authors suggest that interventions such as this may help influence physicians' behaviors in addressing controversial medical topics with public health implications and help decrease utilization of tests with uncertain value.
  • Supplemental Appendix & Tables 1-5

    Supplemental Appendix. Prostate Cancer Screening-Shared Decision-Making Scale; Supplemental Table 1. Primary Care Physician Behaviors in Provision of Information Around Prostate Cancer or Prostate Cancer Screening; Supplemental Table 2. Primary Care Physician Behaviors in Eliciting Patients' Perspectives About Prostate Cancer or Prostate Cancer Screening; Supplemental Table 3. Primary Care Physician Behaviors in Guiding Patient in Final Decision Making around Prostate Cancer Screening; Supplemental Table 4. Summary of Primary Care Physician Behaviors in Shared Decision Making Around Prostate Cancer or Prostate Cancer Screening; Supplemental Table 5. Summary of Physician Final Clinical Recommendations About Prostate Cancer Screening After Prompting by Unannounced Standardized Patient

    Files in this Data Supplement:

    • Supplemental data: Appendix & Tables 1-5 - PDF file, 7 pages, 414 KB
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The Annals of Family Medicine: 11 (4)
The Annals of Family Medicine: 11 (4)
Vol. 11, Issue 4
July/August 2013
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Physician Communication Regarding Prostate Cancer Screening: Analysis of Unannounced Standardized Patient Visits
Bo Feng, Malathi Srinivasan, Jerome R. Hoffman, Julie A. Rainwater, Erin Griffin, Marko Dragojevic, Frank C. Day, Michael S. Wilkes
The Annals of Family Medicine Jul 2013, 11 (4) 315-323; DOI: 10.1370/afm.1509

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Physician Communication Regarding Prostate Cancer Screening: Analysis of Unannounced Standardized Patient Visits
Bo Feng, Malathi Srinivasan, Jerome R. Hoffman, Julie A. Rainwater, Erin Griffin, Marko Dragojevic, Frank C. Day, Michael S. Wilkes
The Annals of Family Medicine Jul 2013, 11 (4) 315-323; DOI: 10.1370/afm.1509
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Subjects

  • Domains of illness & health:
    • Prevention
  • Methods:
    • Quantitative methods
  • Core values of primary care:
    • Personalized care
  • Other topics:
    • Communication / decision making

Keywords

  • prostate cancer
  • prostate cancer screening
  • primary care
  • shared decision making
  • unannounced standardized patients
  • qualitative analysis
  • medical education
  • randomized controlled trial
  • health communication
  • risk-benefit assessment
  • patient-centered care

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