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HEALTH CARE REFORM
Prostate Cancer Screening DecisionsResults From the National Survey of Medical Decisions (DECISIONS Study)
Richard M. Hoffman, MD, MPH;
Mick P. Couper, PhD;
Brian J. Zikmund-Fisher, PhD;
Carrie A. Levin, PhD;
Mary McNaughton-Collins, MD, MPH;
Deborah L. Helitzer, ScD;
John VanHoewyk, PhD;
Michael J. Barry, MD
Arch Intern Med. 2009;169(17):1611-1618.
Background Guidelines recommend informing patients about the risks and benefits of prostate cancer screening. We evaluated the medical decision-making process for prostate-specific antigen (PSA) testing.
Methods We conducted a telephone survey of a randomly selected national sample of 3010 English-speaking US adults 40 years and older. Included in the survey were 375 men who had either undergone or discussed (with health care providers [HCPs]) PSA testing in the previous 2 years. We asked subjects about sociodemographic characteristics, prostate cancer screening discussion features, prostate cancer knowledge, and the importance of various decision factors and sources of information.
Results Overall, 69.9% of subjects discussed screening before making a testing decision, including 14.4% who were not tested. Health care providers most often (64.6%) raised the idea of screening, and 73.4% recommended PSA testing. Health care providers emphasized the pros of testing in 71.4% of discussions but infrequently addressed the cons (32.0%). Although 58.0% of subjects felt well-informed about PSA testing, 47.8% failed to correctly answer any of the 3 knowledge questions. Only 54.8% of subjects reported being asked for their screening preferences. An HCP recommendation (odds ratio, 2.67; 95% confidence interval, 1.08-6.58) was the only discussion characteristic associated with testing. Valuing HCP information was also associated with testing (odds ratio, 1.26; 95% confidence interval, 1.04-1.54).
Conclusions Recommendations and information from HCPs strongly influenced testing decisions. However, most prostate cancer screening decisions did not meet criteria for shared decision making because subjects did not receive balanced discussions of decision consequences, had limited knowledge, and were not routinely asked for their preferences.
Author Affiliations: Medicine Services, New Mexico VA Health Care System, Albuquerque (Dr Hoffman); Departments of Medicine (Dr Hoffman) and Family and Community Medicine (Dr Helitzer), University of New Mexico School of Medicine, Albuquerque; Survey Research Center, Institute for Social Research (Drs Couper, Zikmund-Fisher, and VanHoewyk), Department of Medicine (Dr Zikmund-Fisher), and Center for Behavioral and Decision Sciences in Medicine (Drs Couper and Zikmund-Fisher), University of Michigan, Ann Arbor; VA Health Services Research & Development Center of Excellence, Ann Arbor VA Health Care System, Ann Arbor (Dr Zikmund-Fisher); Foundation for Informed Medical Decision Making, Boston, Massachusetts (Dr Levin); and Division of General Medicine, Massachusetts General Hospital, Boston (Drs McNaughton-Collins and Barry).
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