One-fourth of FPs order PSA without discussing it

Nearly a quarter of family physicians order PSA tests without discussing the test with patients, according to a recent study.

Researchers from the University of Texas MD Anderson Cancer Center, Houston, surveyed members of the American Academy of Family Physicians National Research Network between July 2007 and January 2008. The survey included an indicator of practice styles related to discussing harms and benefits of PSA testing and providing a screening recommendation or letting patients decide, as well as indicators reflecting physicians’ beliefs about prostate cancer screening. Of the 426 physicians contacted, 246 completed the questionnaire.

Analysis of survey responses found that 24% of physicians ordered screening without discussion. In comparison, 48% of physicians discussed harms and benefits with patients and then let them decide. The latter physicians were more likely to believe that scientific evidence does not support screening, that patients should be told about the lack of evidence, and that patients have a right to know the limitations of screening. They were also less likely to endorse the belief that there was no need to educate patients because they wanted to be screened.

Notably, the authors, led by Robert J. Volk, PhD, also found that physicians who discuss the harms and benefits and recommend the test more often expressed concerns about the legal risk associated with not screening compared with physicians who discuss and let the patient decide.

"Much of the variability in physicians’ use of an informed decision-making process can be attributed to beliefs about screening," Dr. Volk and colleagues wrote. "Concerns about medicolegal risk remain an important barrier for shared decision making.

Study results were published in the Annals of Family Medicine (2013; 11:67-74).

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