The Importance of Patient Preference in the Decision to Screen for Prostate Cancer. Prostate Patient Outcomes Research Team

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 1996 Jun 1

PMID 8803740

Citations 65

Authors

A B Flood

J E WENNBERG

R F Nease Jr

F J Fowler Jr

J Ding

L M HYNES

Affiliations

Soon will be listed here.

Abstract

Objective: Routine screening for prostate cancer is controversial because of frequent false-positive results, the potential for slow, non-life-threatening growth of untreated cancer, the uncertainty regarding whether treatment can extend life, and the potential for treatment complications. This study examines how information about prostate-specific antigen (PSA) testing and the uncertain benefits of treating prostate cancer affects patients' desire for PSA testing.

Design: An educational videotape designed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was presented to two groups of male patients 50 years of age or older.

Setting: Dartmouth-Hitchcock Medical Center.

Patients/participants: For study 1, men seeking a free prostate cancer screening were preassigned to view the educational videotape (N = 184) or another videotape (N = 185). For study 2, men scheduled to visit a general internal medicine clinic viewed either the educational videotape (N = 103) or no videotape (N = 93).

Measurements And Main Results: The men's information and preferences about prostate cancer screening and treatment and actual choice of PSA test at the next test opportunity were measured. Men who viewed the educational videotape were: better informed about PSA tests, prostate cancer, and its treatment; preferred no active treatment if cancer were found; and preferred not to be screened (all significant at p < or = .002 in both studies). Men viewing the educational video were less likely to have a PSA test (p = .041, study 2). This tendency was not significant at the free-PSA clinic (p = .079).

Conclusions: Preference regarding cancer screening and treatment is greatly affected by information about medical uncertainties. Because informed patient choices vary. PSA screening decisions should incorporate individual preferences.

Citing Articles

Decision aids for people facing health treatment or screening decisions.

Stacey D, Lewis K, Smith M, Carley M, Volk R, Douglas E Cochrane Database Syst Rev. 2024; 1:CD001431.

PMID: 38284415 PMC: 10823577. DOI: 10.1002/14651858.CD001431.pub6.

Let's Require Patients to Review a High-quality Decision Aid Before Receiving Important Tests and Treatments.

Fowler Jr F, Barry M, Sepucha K, Moulton B Med Care. 2020; 59(1):1-5.

PMID: 33136712 PMC: 7737866. DOI: 10.1097/MLR.0000000000001440.

Decisional autonomy undermines advisees' judgments of experts in medicine and in life.

Kassirer S, Levine E, Gaertig C Proc Natl Acad Sci U S A. 2020; 117(21):11368-11378.

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Machine learning to support social media empowered patients in cancer care and cancer treatment decisions.

De Silva D, Ranasinghe W, Bandaragoda T, Adikari A, Mills N, Iddamalgoda L PLoS One. 2018; 13(10):e0205855.

PMID: 30335805 PMC: 6193663. DOI: 10.1371/journal.pone.0205855.

Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy.

Ubel P, Scherr K, Fagerlin A Am J Bioeth. 2017; 17(11):31-39.

PMID: 29111936 PMC: 6312722. DOI: 10.1080/15265161.2017.1378753.

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