Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care.

Eric A. Klein,Anita D. Misra-Hebert,Grant Hom,J. Stephen Jones,Michael W. Kattan,Janine M. Bauman,Xinge Ji,Niyati Gupta,Andrew J. Stephenson

doi:10.3389/fonc.2018.00238

Eric A. Klein, Anita D. Misra-Hebert + Show 7 more

Open Access

https://doi.org/10.3389/fonc.2018.00238

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Abstract

As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed. A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients' knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar's and Stuart-Maxwell tests were used to compare pre-and post-survey responses. 14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40-69 at the five clinics with 2-10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009). A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients' knowledge about the screening decision.

Highlights

The current US Preventive Services Task Force (USPSTF) Prostate Cancer (PCa) Screening Recommendations for men aged 55–69 suggest individualized decision-making for the PCa screening decision after a discussion with a clinician of benefits, harms, and consideration of a patient’s values and preferences [1]
Further analysis of the proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect risk for PCa from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009)
Our study demonstrated the feasibility of using a PCa screening conversation tool in busy primary-care settings to address important aspects of the PCa screening discussion

Summary

Introduction

The current US Preventive Services Task Force (USPSTF) Prostate Cancer (PCa) Screening Recommendations for men aged 55–69 suggest individualized decision-making for the PCa screening decision after a discussion with a clinician of benefits, harms, and consideration of a patient’s values and preferences [1]. The goal of the tool is to aid PCa screening discussions where the patient and provider can discuss the risks and benefits of PCa screening given a patient’s individual risk factor, health status, and preferences. We tested this tool with primary care providers and patients to determine its ease of use for providers and patients and to describe the responses in primary care settings. As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed

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Conclusion