Abstract
BackgroundLack of time and competing demands limit the ability of patients and providers to engage in informed decision-making discussions about prostate cancer screening during primary care visits. We evaluated a patient recall invervention to mitigate these challenges.MethodsUsing mail and telephone outreach we invited men age 50-74 years without a PSA test in the prior 12 months to make appointments with their primary care providers in order to discuss the pros and cons of PSA-based prostate cancer screening. We assessed patient responsiveness to the program, provider documentation of screening discussions, orders for PSA laboratories, and provider attitudes.ResultsOut of 80 eligible patients, 37 (46%) scheduled and 28 (35%) completed a recall appointment. A large majority (91%) of patients eligible for PSA screening received an order for this test. Providers documented PSA discussions more often for these patients than for a recent sample of their other patients who received traditional care (47.8% vs. 12.5%, p = 0.009). Twelve of 14 participating providers felt the program improved their ability to impart information about the risks and benefits of screening, but were uncertain whether it influenced their patients' preexisting preferences for screening. Some expressed doubts about the advisability of PSA-specific appointments.ConclusionTo a limited extent, this pilot recall intervention enhanced opportunities for discussions of prostate cancer screening between patients and their primary care providers. As currently configured, however, this program was not found to be feasible for this purpose. A future version should promote screening discussions in the context of a broader range of health maintenance concerns and include more detailed, low-literacy information to educate patients in advance of clinic visits.
Highlights
Lack of time and competing demands limit the ability of patients and providers to engage in informed decision-making discussions about prostate cancer screening during primary care visits
The prostate specific antigen (PSA) test combined with a digital rectal exam (DRE) can detect prostate cancer early; there is little highquality evidence that screening and current treatments, many of which have disabling side effects, reduce mortality [1]
Patient Population Based on automated electronic health record (EHR, Allscripts Touchworks, version 10, Chicago, IL) abstraction, men were deemed to meet initial inclusion criteria if they were age 50 to 74 years, had an attending primary care provider (PCP), had seen a PCP in the practice at least once in the preceding 18 months, and did not have an administrative claim for a PSA test within the past 12 months
Summary
Lack of time and competing demands limit the ability of patients and providers to engage in informed decision-making discussions about prostate cancer screening during primary care visits. The prostate specific antigen (PSA) test combined with a digital rectal exam (DRE) can detect prostate cancer early; there is little highquality evidence that screening and current treatments, many of which have disabling side effects, reduce mortality [1] For this reason, professional organizations including the American Cancer Society and the United States Preventive Services Task Force (USPSTF) recommend that before proceeding with screening, men have an informed discussion with their health care providers regarding the risks and benefits of the PSA test [2]. Professional organizations including the American Cancer Society and the United States Preventive Services Task Force (USPSTF) recommend that before proceeding with screening, men have an informed discussion with their health care providers regarding the risks and benefits of the PSA test [2] This recommendation is extremely challenging to implement [3]. Providers who are unaware of screening guidelines may assign limited importance to informed decision-making or may be inexperienced with such discussions [6]
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