How underlying patient beliefs can affect physician-patient communication about prostate-specific antigen testing. Eff Clin Pract 2002;5(3):120-9
Date
06/29/2002Pubmed ID
12088291Scopus ID
2-s2.0-0036560922 (requires institutional sign-in at Scopus site) 57 CitationsAbstract
CONTEXT: Routine cancer screening with prostate-specific antigen (PSA) is controversial, and practice guidelines recommend that men be counseled about its risks and benefits.
OBJECTIVE: To evaluate the process of decision making as men react to and use information after PSA counseling.
DESIGN: Written surveys and semistructured qualitative interviews before and after a neutral PSA counseling intervention.
PARTICIPANTS: Men 40 to 65 years of age in southeastern Michigan were recruited until thematic saturation--that is, the point at which no new themes emerged in interviews (n = 40).
RESULTS: In a paper survey, 37 of 40 participants (93%) said that they interpreted the counseled information as unfavorable toward PSA. However, 30 participants (75%) said after the intervention that they intended to be tested in the future, including 29 of 30 men (97%) with prior PSA testing. In the interview, many participants cited underlying beliefs as a reason to dismiss the counseled information. Qualitative analysis found the seven most common beliefs cited were fear of cancer, relevance of salient anecdotes and analogies, distrust of statistics, enthusiasm for "prevention," protection from "bad luck," faith in science, and valuing PSA as knowledge for its own sake. Although some beliefs could be interpreted as judgment errors, most were credible on a personal level.
CONCLUSIONS: Most men who underwent PSA counseling cited underlying beliefs rather than the content of counseled information as the basis for their decisions regarding future PSA screening. If widespread, such beliefs may render clinician counseling and decision support methods less effective. Eliciting patient beliefs prior to counseling may improve the shared decision-making process.
Author List
Farrell MH, Murphy MA, Schneider CEMESH terms used to index this publication - Major topics in bold
AdultAged
Decision Making
Diagnostic Tests, Routine
Health Services Research
Humans
Interviews as Topic
Male
Michigan
Middle Aged
Patient Acceptance of Health Care
Patient Participation
Physician-Patient Relations
Practice Guidelines as Topic
Prostate-Specific Antigen
Prostatic Neoplasms
Qualitative Research
