On TRACK: ‘Allows Readers and Authors to Go One Step Further’

Kurt C. Stange

doi:10.1370/afm.630

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Absence of Discussion Between Physician and Patient About PSA Test Does Not Mean Patient Does Not Know the Advantages and Disadvantages of the Test
Alfred A Rimm

Published on: 01 October 2006

Published on: (1 October 2006)
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Absence of Discussion Between Physician and Patient About PSA Test Does Not Mean Patient Does Not Know the Advantages and Disadvantages of the Test
Alfred A Rimm, Cleveland, USA
Dr. McFall’s (Ann Fam Med. 2006;4:433-436) study of communication between doctor and patient about the advantages/disadvantages (A/D) of the PSA test, suggests that 63% of tested men reported having this discussion about their most recent PSA test. This overall finding may be somewhat misleading because it suggests that 37% of the patients are not aware of the A/D of the PSA test. The 63% may be a considerable understat...
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Dr. McFall’s (Ann Fam Med. 2006;4:433-436) study of communication between doctor and patient about the advantages/disadvantages (A/D) of the PSA test, suggests that 63% of tested men reported having this discussion about their most recent PSA test. This overall finding may be somewhat misleading because it suggests that 37% of the patients are not aware of the A/D of the PSA test. The 63% may be a considerable understatement of the patient’s knowledge of the A/D of the test. This is due to the fact that there is no question in the National Health Interview Study, which is an ongoing cross-sectional survey each year conducted by the NIH, which asks whether the patient already had knowledge of the A/D of the PSA before their most recent test. In light of this, it might be misleading to imply that 37% of men receiving their most recent PSA are not aware of its A/D. For those men who never had a PSA test in the past 5 years, 52.5% recalled having a discussion of the A/D even though the test was performed more than five years ago. It is likely that many of the men who had one or more tests during the past five years also had one or more tests more than five years ago; therefore, the patients who had a test in the past five years may have had prior knowledge of the A/D. It is possible that all of the men who had no discussion of the A/D at their most recent test had prior knowledge of the A/D and didn’t need a discussion with their physician.
Unfortunately, the interview did not include a question like, “Have you ever been told of the A/D of the PSA prior to the most recent test?” For example, if this question was asked of the 786 men who had 5 or more PSA tests in the past five years, 100% may have answered “yes.” These men received one or more tests per year and with this high utilization rate it is very likely that all of them know the A/D. The results show that 67.9% of these men had a discussion with their physician during their most recent test, the remaining 32.1% probably knew of the A/D.
Because of the nature of the questions asked in the survey, the study gives results about the rate that discussions occur, not the percentage of patients who have knowledge about the A/D of the test. If the major objective of the study is to determine the rate of A/D discussions at each visit for PSA testing, this study gives a good estimate of the rate. The study does not address the problem of what percentage of patients know about the A/D of the PSA test when they have the test. The above issues contrasting physician behavior with patient knowledge should have been discussed in the paper and abstract so that the results are not misinterpreted.
Competing interests: None declared
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Competing Interests: None declared.