Article Figures & Data
Figures
- 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
- Table 1
Primary Care Physician Behaviors in Provision of Information Around Prostate Cancer or Prostate Cancer Screening: 16 Coded Items
Provision of Information Overall (N=118) % Control (n=57) % Intervention (n=61) % Discusses incidence or prevalence of prostate cancer 44 46 41 Discusses risk factors for prostate cancer 45 37 53 Discusses natural history of prostate cancer 53 51 54 Discusses mortality of prostate cancer 61 53 69 Discusses controversies of PCS 49 39 60 Discusses benefits of PSA testing 87 88 87 Discusses problems with accuracy of PCS 91 88 93 Discusses other drawbacks of PSA testinga 70 60 80 Mentions no screening as an alternativea 45 26 63 Mentions rectal examination as an alternative 87 93 83 Discusses benefits of rectal examination 58 63 54 Discusses drawbacks of rectal examination 34 32 36 Discusses benefits of watchful waiting/no screening 31 21 41 Discusses drawbacks of watchful waiting/no screening 31 32 30 Informs next steps after abnormal PSA test 78 70 85 Informs next steps after normal PSA test 24 26 22 -
PCS=prostate cancer screening; PSA=prostate-specific antigen.
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Note: Percentage of physicians who provided information about prostate cancer or prostate cancer screening at least once during an unannounced standardized patient visit.
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↵a P <.05.
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- Table 2
Primary Care Physician Behaviors in Eliciting Patients’ Perspectives About Prostate Cancer or Prostate Cancer Screening: 12 Coded Items
Elicitation of Patient Perspectives Overall (N=118) % Control (n=57) % Intervention (n=61) % Asks about patient’s direct previous experience 46 53 40 Ask about patient’s family history 47 40 54 Asks about patient’s indirect personal experiencea 8 2 15 Asks about patient’s knowledge 3 0 5 Asks about patient’s concerns about having PCAa 7 2 12 Solicits concerns about having side effects from test or treatmenta 3 0 7 Offers opportunities to ask questions 13 12 13 Checks patient’s understanding of information 25 19 30 Explains why shared decision making is necessary for PCS 28 21 34 Elicits patient’s preferred level of involvement in decisions 0 0 0 Assesses patient’s preferences for receipt of information 0 0 0 Asks patient his decision 34 28 39 -
PCS=prostate cancer screening; PSA=prostate-specific antigen.
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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.
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↵a P <.05.
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- Table 3
Primary Care Physicians Behaviors in Guiding Patient in Final Decision Making Around Prostate Cancer Screening: 4 Coded Items
Guiding Final Decision Overall (N=118) % Control (n=57) % Intervention (n=61) % Indicates that decisions should be based on patient’s valuesa 19 11 28 Tells patient to think about optionsa 51 39 62 Encourages patient to seek input from othersa 16 7 25 Offers to provide additional informationa 27 18 36 -
Note: Percentage of physicians who provided guidance for final decision making regarding prostate cancer screening, at least once during an unannounced standardized patient visit.
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↵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
Behavior Range Overall (N=118) Mean No. Control (n=57) Mean No. Intervention (n=61) Mean No. Overall shared decision making–PCS scorea 0–32 12.2 10.7 13.5 Provision of information scale 0–16 8.9 8.2 9.5 Elicitation of patient’s perspectives scale 0–12 2.1 1.8 2.5 Guiding decision-making scalea 0–4 1.1 0.7 1.5 -
PCS=prostate cancer screening.
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Note: Each item in the scale was given a value of 0 = did not occur, or 1 = occurred.
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↵a P <.05.
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- Table 5
Summary of Physician Final Clinical Recommendations After Prompting by Unannounced Standardized Patient
Recommendation Overall (N=118) % Control (n=57) % Intervention (n=61) % Recommended in favor of PCS 59 68 49 Recommended against PCS 16 11 21 Made no recommendation 25 21 30 Physician stated that he or she would order a PSA blood testa 45 60 31 -
PCS=prostate cancer screening; PSA=prostate-specific antigen.
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↵a P <.01.
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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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