Friday, April 27, 2012
QD: News Every Day--Internists reluctant to stop PSA testing in elderly men
Elderly men expect to receive prostate-specific antigen (PSA) tests and doctors continue to conduct them, sometimes even in men with low life expectancy despite the recommendations against the practice. Patients' expectations and the time it would take to dissuade them are two main reasons, a study found.
Doctors know they shouldn't do prostate-specific antigen (PSA) tests in older men, but they do them anyway--at a brisk pace. An estimated 57% of men ages 75 to 79 years and approximately 33% of men with low life expectancies received screening within the past year, according to Johns Hopkins researchers who delved into the barriers to physicians stopping PSA screening.
The researchers surveyed physicians at Johns Hopkins Community Physicians, a university-affiliated practice comprised of 26 outpatient sites in 11 counties in Maryland. Providers were asked about screening practices, factors that influenced their decision to discontinue screening and what stopped them from stopping PSA screens. Resultsappeared in Cancer.
Responses from 125 of 141 providers (88.7%) showed that 17.2% of participants said they ordered PSA screening without discussing it with their patients, and 33.6% said they discussed PSA screening and typically recommended it. When providers ordered PSA screening, they overwhelmingly (90%) ordered it annually.
59.3% took age and life expectancy into account, while 12.2% did not consider either in their decisions to discontinue PSA screening. Nearly one-third of providers (32.5%) said that they did not have an age at which they typically stop recommending PSA screening. Among the 67.5% who said they stopped screening based on age, 26.8% stopped screening starting at age 70, 52.4% at 75, and 20.7% at 80.
The most frequently cited barriers to discontinuing PSA screening were patient expectation (74.4%) and time constraints (66.4%). The majority of providers agreed or strongly agreed that they typically took life expectancy into account when ordering PSA screening (76.8%).
Providers who stated that they had an age at which they typically discontinued screening also were significantly more likely to take life expectancy into account. However, 66.4% of providers described it as very difficult or somewhat difficult to estimate life expectancy in clinical practice, and 69.1% wanted a clinical decision support tool that would help predict mortality.
The authors wrote, "[I]nterventions will need to teach clinicians to take age and life expectancy into account when deciding whether to initiate and continue screening. For providers that already consider these factors, the development of tools that help clinicians more accurately and quickly estimate life expectancy may be an important next step."
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
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Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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