The influence of physician recommendation on prostate-specific antigen screening.

Prostate-specific antigen (PSA) screening is controversial, and little is known regarding a physician's effect on a patient's decision to undergo screening. This study's objective was to evaluate the effect of a patient's understanding of the risks and benefits of screening compared to the final recommendation of the provider on the patient's decision to undergo PSA screening.

Using the 2012 Behavioral Risk Factor Surveillance System, men older than 55 years who did not have a history of prostate cancer/prostate "problem" and who reported a PSA test within the preceding year were considered to have undergone screening. The percentages of men informed and not informed of the risks and benefits of screening and the percentage men receiving recommendations for PSA screening from their provider were reported. Multivariable complex-sample logistic regression calculated the odds of undergoing screening.

In all, 75% of men were informed of screening benefits; however, 32% were informed of screening risks. After being informed of both, 56% of men opted for PSA screening if the provider recommended it, compared with only 21% when not recommended. Men receiving a recommendation to undergo PSA testing had higher odds of undergoing screening (odds ratio [OR] = 4. 98, 95% CI: 4. 53-5. 48) compared with those who were only informed about screening benefits (OR = 2. 40, 95% CI: 2. 18-2. 65) or risks (OR = 0. 92, 95% CI: 0. 86-0. 98). Significant limitations include recall and nonresponse bias.

Patients' decision to undergo or forgo PSA screening is heavily influenced by the recommendation of their physician; it is imperative that physicians are cognizant of their biases and facilitate a shared decision-making process.

Urologic oncology. 2015 Jul 20 [Epub ahead of print]

Daniel Pucheril, Deepansh Dalela, Jesse Sammon, Akshay Sood, Maxine Sun, Quoc-Dien Trinh, Mani Menon, Firas Abdollah

VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI. , VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI. , VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI. , VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI. , Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. , Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. , VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI. , VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI. 

PubMed