Distribution of Physician Characteristics and Responses to Screening Beliefs Indicators, by the 3 Most Common Clinical Practice Styles for Prostate Cancer Screening
| Practice Style and Belief Endorsement, %a | |||||
|---|---|---|---|---|---|
| Variable | Score for Beliefs Indicators, Mean (SD)b | Screen Without Discussion (n = 59) | Discuss, Recommend Screening (n = 55) | Discuss, Let Patient Decide (n = 116) | PValuec |
| Physician characteristics | |||||
| Sex, male | 75.9 | 73.6 | 68.7 | .577 | |
| Academically affiliated practice | 3.6 | 41.5 | 56.6 | <.001 | |
| Beliefs indicators | |||||
| Screening/treatment efficacy | |||||
| The benefits of prostate cancer screening outweigh the risks | 3.40 (1.00) | 76.3 | 69.1 | 16.5 | <.001 |
| I have wondered if treatment for prostate cancer is worth it for some patients | 3.65 (0.97) | 50.8 | 64.8 | 87.9 | <.001 |
| Scientific evidence | |||||
| There is clear evidence that prostate cancer screening saves lives | 2.52 (0.99) | 30.5 | 30.9 | 1.7 | <.001 |
| My clinical experience is more important than research studies in how I handle screening | 2.96 (1.21) | 25.4 | 25.9 | 3.4 | <.001 |
| The scientific evidence does not support routine screening for prostate cancer | 3.31 (0.88) | 20.3 | 23.6 | 71.6 | <.001 |
| Evidence-based medicine orientation | |||||
| I would describe myself as someone who practices evidence-based medicine | 3.97 ( 0.53) | 71.2 | 87.3 | 90.5 | .003 |
| Professional experience | |||||
| I have lost patients to prostate cancer who might have been saved if they had been screened with PSA | 2.51 (1.08) | 27.6 | 27.8 | 16.4 | .119 |
| Personal experience | |||||
| I have lost close family members or friends to prostate cancer | 2.34 (1.29) | 28.8 | 25.9 | 22.4 | .638 |
| Prescreening discussion | |||||
| Patients should be told that it has yet to be proven that prostate cancer screening saves lives | 3.82 (0.95) | 35.6 | 61.8 | 90.5 | <.001 |
| Patients’ rights | |||||
| Patients have a right to know the implications of prostate cancer screening before they are screened | 4.20 (0.70) | 52.5 | 92.7 | 98.3 | <.001 |
| Patients’ expectations | |||||
| There is no need to educate patients about prostate cancer screening because in general they want to be screened | 2.42 (1.11) | 54.2 | 22.2 | 6.9 | <.001 |
| My patients frequently request the PSA test | 3.87 (0.79) | 83.1 | 73.6 | 63.8 | .026 |
| Patient anxiety | |||||
| Discussing harms and benefits of prostate cancer screening causes unnecessary anxiety in my patients | 2.62 (0.96) | 32.2 | 25.5 | 14.8 | .024 |
| Regret | |||||
| There have been times when I have regretted ordering a PSA test for a patient | 2.96 (1.21) | 25.4 | 39.6 | 56.9 | <.001 |
| Malpractice concerns | |||||
| Not ordering a PSA test puts a physician at risk for malpractice liability | 3.82 (0.90) | 76.3 | 87.3 | 63.8 | .004 |
| Community standards | |||||
| Prostate cancer screening is a standard of care in my community | 4.02 (0.75) | 94.8 | 90.9 | 64.7 | <.001 |
| Time barriers | |||||
| I do not have time to discuss the harms and benefits of prostate cancer screening with my patients | 2.67 (1.06) | 42.4 | 18.2 | 22.4 | .005 |