Article Figures & Data
Figures
- Figure 1.
Patient-reported locus of decision-making control in relation to the Merenstein case (N = 431 question respondents).
Note: The figure shows patients’ responses to the survey question, “How was the decision made today on whether to do a PSA blood test? (A) I made the decision on whether to order a PSA test. (B) I made the decision about whether to order a PSA test after seriously considering my doctor’s opinion. (C) My doctor and I shared the responsibility for deciding whether to order a PSA test. (D) My doctor made the final decision about whether to order a PSA test after seriously considering my opinion. (E) My doctor made the decision whether to order a PSA test.” Before period = January 2002 through June 2003; diffusion period = July 2003 through December 2003; after period = January 2004 through November 2004. The differences across the 3 time periods are not significant (P = .54).
- Figure 2.
Patient-reported elements of the prostate cancer screening discussion in relation to the Merenstein case (N = 432).
PSA = prostate-specific antigen.
Note: The figure shows temporal trends of measured elements of the prostate cancer screening process in relation to the Merenstein case (before, diffusion, and after periods) as reported by 432 patients who returned a completed questionnaire. The left-hand axis and black lines represent an ordinal scale from 1 to 10. The right-hand axis and gray lines represent a percentage scale from 0% to 100%. Comparing the before and after time periods, the differences are not significant for decisional conflict (P = .23), number of topics discussed (P = .37), time spent on discussion (P = .20), and knowledge (P = .86). The percentage of patients receiving a PSA test increased, however (84% vs 90%; P = .03).
Tables
Characteristic Before Period (n = 180) Diffusion Period (n = 87) After Period (n = 165) PValue* PSA = prostate-specific antigen. * Calculated across the 3 time periods using the Kruskal-Wallis test. † Aggregate P value for population characteristic. Age, mean, years 58 57 56 0.13 Race, % White 89 91 93 0.59 African American 3 2 2 1.00 College education or higher, % 85 85 82 0.64 Prior testing for PSA, % 70 70 65 0.41 Type of physician seen, % 0.02† Faculty 77 70 65 Second-year resident 7 12 18 Third-year resident 16 18 16 Group randomized to, % 0.39† Control 17 16 13 Brochure decision aid 39 32 43 Web-based decision aid 44 52 44
The Article in Brief
How Physicians Approach Prostate Cancer Screening Before and After Losing a Lawsuit
Alex H. Krist, MD, MPH, and colleagues
Background In 1999, a family medicine resident and a patient shared decision-making about whether the patient would be screened for prostate cancer. The patient, who decided not to be screened, was later diagnosed with prostate cancer and successfully sued the practice. This study examines whether doctors at the practice changed their approach to shared decision-making for prostate cancer screening as a result of the lawsuit.
What This Study Found Doctors in the practice did not change their approach to involving patients in decision-making for prostate cancer screening before, during, or after becoming aware of the lawsuit.. They continued to spend time discussing issues related to prostate cancer screening and patients were equally well informed about it.
Implications
- This study casts doubt on the idea that doctors change their practice methods as a result of the threat or experience of a lawsuit.
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