Abstract
Objective
This study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior.
Methods
We analyzed data from the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression.
Results
Eighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31–40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice.
Conclusions
Both individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S.
Similar content being viewed by others
References
Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010;60:70–98.
Voss JD, Schectman JM. Prostate cancer screening practices and beliefs. J Gen Intern Med. 2001;16:831–7.
Ross LE, Taylor YJ, Richardson LC, Howard DL. Patterns in prostate-specific antigen test use and digital rectal examinations in the Behavioral Risk Factor Surveillance System, 2002–2006. J Natl Med Assoc. 2009;101:316–24.
Swan J, Breen N, Graubard BI, McNeel TS, Blackman D, Tangka FK, Ballard-Barbash R. Data and trends in cancer screening in the United States: Results from the 2005 National Health Interview Survey. Cancer. 2010;116:4872–81.
Ross LE. Zahava Berkowitz Z, Donatus U. Ekwueme DU. Use of the Prostate-Specific Antigen Test among U.S. Men: Findings from the 2005 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2008;17(3):636–44.
National Guideline Clearinghouse. Guideline synthesis: screening for prostate cancer. Available at: http://www.guideline.gov. Accessed February 15, 2011.
Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2009;59:27–41.
Lim LS, Sherin K. Screening for prostate cancer in U.S. men ACPM position statement on preventive practice. Am J Prev Med. 2008;34:164–70.
Guerra CE, Jacobs SE, Holmes JH, Shea JA. Are physicians discussing prostate cancer screening with their patients and why or why not? A pilot study. J Gen Intern Med. 2007;22:901–7.
Linder SK, Hawley ST, Cooper CP, Scholl LE, Jibaja-Weiss M, Volk RJ. Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey. BMC Fam Pract. 2009;10:1–6.
Han PK, Coates RJ, Uhler RJ, Breen N. Decision making in prostate-specific antigen screening: National Health Interview Survey, 2000. Am J Prev Med. 2006;30:394–404.
McFall SL. US men discussing prostate-specific antigen tests with a physician. Ann Fam Med. 2006;4:433–6.
Tannor BB, Ross LE. Physician–patient discussions about prostate-specific antigen test use among African-American men. J Natl Med Assoc. 2006;98:532–8.
Dunn AS, Shridharani KV, Lou W, Bernstein J, Horowitz CR. Physician–patient discussions of controversial cancer screening tests. Am J Prev Med. 2001;20:130–4.
Wolf AM, Becker DM. Cancer screening and informed patient discussions. Truth and consequences. Arch Intern Med. 1996;156:1069–72.
Pendleton J, Curry RW, Kaserian A, et al. Knowledge and attitudes of primary care physicians regarding prostate cancer screening. J Natl Med Assoc. 2008;100:666–70.
Cooper CP, Merritt TL, Ross LE, John LV, Jorgensen CM. To screen or not to screen, when clinical guidelines disagree: primary care physicians' use of the PSA test. Prev Med. 2004;38:182–191.
Stroud LA, Ross LE, Rose SW. Formative evaluation of the prostate cancer screening practices of African-American physicians. J Natl Med Assoc. 2006;98:1637–43.
Hoffman RM, Couper MP, Zikmund-Fisher BJ, et al. Prostate cancer screening decisions: results from the National Survey of Medical Decisions (DECISIONS study). Arch Intern Med. 2009;169:1611–8.
Drummond FJ, Sharp L, Comber H. Major inter-laboratory variations in PSA testing practices: results from national surveys in Ireland in 2006 and 2007. Ir J Med Sci. 2008;177:317–23.
Jordan TR, Price JH, King KA, Masyk T, Bedell AW. The validity of male patients' self-reports regarding prostate cancer screening. Prev Med. 1999;28:297–303.
Volk RJ, Cass AR. The accuracy of primary care patients' self-reports of prostate-specific antigen testing. Am J Prev Med. 2002;22:56–8.
Acknowledgements
1)Contributors: All contributors are listed as co-authors
2)Funders: This work was funded by the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
3)Prior presentations: Hall IJ, Ross LE, Richardson LC, Taylor YJ. Primary Care Physicians’ Discussions about Prostate Cancer Screening. Poster presented at NIH Summit on Health Disparities, National Harbor, MD, December, 2008
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Additional information
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOC 63 kb)
Rights and permissions
About this article
Cite this article
Hall, I.J., Taylor, Y.J., Ross, L.E. et al. Discussions About Prostate Cancer Screening Between U.S. Primary Care Physicians and Their Patients. J GEN INTERN MED 26, 1098–1104 (2011). https://doi.org/10.1007/s11606-011-1682-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-011-1682-0