Nearly one in four physicians do not consult with patients before ordering a prostate-specific antigen screening exam, a survey of family physicians found.
Members of the American Academy of Family Physicians National Research Network, described as a voluntary research association of primary care clinicians who collaborate on studies to describe and improve primary care practice, responded to a survey about shared-decision making for PSA screens from July 2007 to January 2008.
Physicians had five choices for ordering the screening exam: screen without discussion; discuss, then recommend screening; discuss, let patient decide; discuss, recommend against; and don’t discuss or recommend).
Next, researchers offered respondents a 5-point Likert scale for 17 common beliefs about PSA screening, such as benefits and harms, weigh of scientific evidence and practice management issues such as time for discussions with patients or malpractice risks.
Results appeared in Annals of Family Medicine.
Compared with physicians who ordered screening without discussion (24.3%), physicians who discussed harms and benefits with patients and then let them decide (47.7%) were more likely to endorse beliefs that scientific evidence does not support screening (odds ratio [OR], 3.628; P=.046), that patients should be told about the lack of evidence (OR, 6.073; P=.003), and that patients have a right to know the limitations of screening (OR, 10.535; P.015); they were also less likely to endorse the belief that there was no need to educate patients because they wanted to be screened (OR, 0.122; P=.001).
One practical solution to time barriers might include pre-exam decisions aids, the researchers noted.
"Patient decision aids may be one solution for physicians who believe limited time with a patient is a barrier to the informed decision-making process and for those who have concerns about the medicolegal risks of not routinely screening men," they wrote. "Decision aids used before the clinical encounter may prepare patients for the informed decision-making process and lessen the process burden on the physician."