Prostate Cancer Screening Decisions Results From the National Survey of Medical Decisions (DECISIONS Study)
Prostate Cancer Screening Decisions Results From the National Survey of Medical Decisions (DECISIONS Study)
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DOI：
10.1001/archinternmed.2009.262
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发表时间：
2009-09-28
影响因子：
--
通讯作者：
Barry, Michael J.
中科院分区：
文献类型：
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作者：
Hoffman, Richard M.;Couper, Mick P.;Barry, Michael J.
背景：指南建议告知患者前列腺癌筛查的风险和益处。我们评估了前列腺特异性抗原 (PSA) 检测的医疗决策过程。方法：我们对随机抽取的 3010 名 40 岁及以上讲英语的美国成年人进行了电话调查。该调查包括 375 名男性，他们在过去 2 年中接受过或与医疗保健提供者 [HCP] 讨论过 PSA 检测。我们向受试者询问了社会人口特征、前列腺癌筛查讨论特征、前列腺癌知识以及各种决策因素和信息来源的重要性。结果：总体而言，69.9% 的受试者在做出测试决定之前讨论了筛查，其中 14.4% 的受试者没有进行测试。医疗保健提供者最常 (64.6%) 提出筛查的想法，73.4% 建议进行 PSA 检测。 71.4% 的讨论中，医疗保健提供者强调了检测的优点，但很少提及其缺点 (32.0%)。尽管 58.0% 的受试者对 PSA 测试感到了解很多，但 47.8% 的受试者未能正确回答 3 个知识问题中的任何一个。只有 54.8% 的受试者表示被询问了他们的筛查偏好。 HCP 建议（比值比，2.67；95% 置信区间，1.08-6.58）是与测试相关的唯一讨论特征。重视 HCP 信息也与测试相关（比值比，1.26；95% 置信区间，1.04-1.54）。结论：HCP 的建议和信息强烈影响测试决策。然而，大多数前列腺癌筛查决策不符合共同决策的标准，因为受试者没有接受关于决策后果的平衡讨论，知识有限，并且不经常询问他们的偏好。
Background: Guidelines recommend informing patients about the risks and benefits of prostate cancer screening. We evaluated the medical decision-making process for prostate-specific antigen (PSA) testing.Methods: We conducted a telephone survey of a randomly selected national sample of 3010 English-speaking US adults 40 years and older. Included in the survey were 375 men who had either undergone or discussed (with health care providers [HCPs]) PSA testing in the previous 2 years. We asked subjects about socio-demographic characteristics, prostate cancer screening discussion features, prostate cancer knowledge, and the importance of various decision factors and sources of information.Results: Overall, 69.9% of subjects discussed screening before making a testing decision, including 14.4% who were not tested. Health care providers most often (64.6%) raised the idea of screening, and 73.4% recommended PSA testing. Health care providers emphasized the pros of testing in 71.4% of discussions but infrequently addressed the cons (32.0%). Although 58.0% of subjects felt well-informed about PSA testing, 47.8% failed to correctly answer any of the 3 knowledge questions. Only 54.8% of subjects reported being asked for their screening preferences. An HCP recommendation (odds ratio, 2.67; 95% confidence interval, 1.08-6.58) was the only discussion characteristic associated with testing. Valuing HCP information was also associated with testing (odds ratio, 1.26; 95% confidence interval, 1.04-1.54).Conclusions: Recommendations and information from HCPs strongly influenced testing decisions. However, most prostate cancer screening decisions did not meet criteria for shared decision making because subjects did not receive balanced discussions of decision consequences, had limited knowledge, and were not routinely asked for their preferences.