ASCO GU 2018: TPS 159 -What Fixes PSA Screening Guidelines Gone Wrong?

San Francisco, CA (UroToday.com) The authors report their study examining patient factors that alter correct recommendation and physician (MD) advice in real-time cancer screening discussions in a 2x2 cluster-randomized trial of MD educational supports.

Methods

The authors enrolled an age-(30-89 years) and sex-stratified sample of 18 patients (PTs) who underwent a physical examination at 2 urban hospitals by 12 primary care MDs. Screening guideline formatting (color-coding [CC]) and academic detailing (AD) were randomly assigned to MDs. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. The authors defined correct recommendations as those going against screening for men older than 75 yrs, or younger (African American [AA] < 40 or non-AA < 50). For other men, either recommendation was considered correct. MD-reported serious comorbidity or PT choice against screening were also valid reasons against screening.

Results:

Of the first 174 patients seen by the MDs, 92 were male. They were racially diverse (69% white) and highly educated (87% attended and 61% graduated college). Using the parameters of age and race alone, 49% of men should not have been screened. However, this increased to 65% by adding comorbidity issues (1%) and PT choice (15%). By these criteria, MDs advised correctly in 91% of encounters. In univariate analysis, CC, PT education, shared decision making and age tended to increase correct recommendations.

Conclusions:

In a highly educated, racially diverse patient population, including comorbidity factors and PT choice, increased the correct recommendation rate against screening in up to 16% more men. An educational support (CC) tended to increase the rate of correct recommendation. Clinical trial information: NCT02430948

Presented by: James Austin Talcott, Strang Cancer Prevention Institute, New York, NY

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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