Physician Communication and Prostate Cancer Screening
By Martin S. Lipsky, MD, Adjunct Professor, Institute on Aging, School of Community Health, Portland State University; Dean Emeritus, University of Illinois College of Medicine, Rockford. Dr. Lipsky reports no financial relationships relevant to this field of study.
Synopsis: A brief web intervention improved shared decision making regarding prostate cancer screening.
Source: Feng B, et al. Physician communication regarding prostate cancer screening: Analysis of unannounced standardized patient visits. Ann Fam Med 2013;11:315-323.
Prostate cancer screening is no longer recommended by the U.S. Preventive Services Task Force for average risk men.1 Feng et al 2 explored how physicians communicate this recommendation to patients and how shared decision making is used by clinicians for prostate cancer screening. The authors defined shared decision making as a communication process through which clinicians collaboratively help patients understand medical information to reach value-congruent medical decisions.
To explore clinicians' communication styles, this study used a standardized patient methodology. Standardized patients are actors trained to role play a clinical scenario in a reproducible and standardized manner. Each standardized patient visited a clinician and during the course of the visit was trained to ask about prostate cancer screening.
The study group physicians were divided into a control and intervention group. The control group received a brochure on prostate cancer screening published by the Centers for Disease Control and Prevention and the intervention group was exposed to an interactive, 30-minute, web-based curriculum that included interactive roulette wheels, illustrative video vignettes, and other content to illustrate the risk and benefits of prostate cancer screening. They also received education about methods to enhance shared decision making.
Each encounter was audio recorded and physician behaviors were analyzed for: 1) engagement of a discussion about prostate cancer screening after prompting, 2) degree of decision making, and 3) recommendations for prostate cancer screening.
The study group included 43 physicians in the control group and 77 in the intervention group. After prompting, 90% of the physicians discussed prostate cancer screening. The intervention group was somewhat more likely to engage in more shared decision-making behaviors, were more likely to mention no screening as an option (63% vs 26%, P < 0.05), to encourage patients to consider different screening options (62% vs 39%, < 0.05), and to mention no screening as an option (63% vs 26%, P < 0.05).
Based on their findings, the authors concluded that a brief web-based interactive education intervention can improve shared decision making, neutrality of recommendation, and in the case of prostate cancer, reduce prostate-specific antigen (PSA) testing.
COMMENTARY
Prostate cancer screening is no longer recommended for average risk men. Despite this, 40-50% of men are still screened.3 Shared decision making is touted as a method of discussing prostate testing and making better decisions about testing, especially when a test is of equivocal value. In the case of prostate cancer, shared decision making has the potential to reduce costs and improve patient care. However, most men in the United States report little shared decision making with their doctor regarding PSA screening.4
The findings reported by Fang et al suggest that a brief web-based intervention has the potential to impact shared decision making, and in the case of prostate cancer, perhaps improve care and reduce costs. While the improvement in shared decision making was modest, the number of physicians who mentioned the option of no screening in the intervention group was more than double the control group. While this study only examined prostate cancer among a relatively small group of primary care physicians working in five health care systems in California, the fact that even a brief, low-cost intervention improved shared decision making seems promising. Future studies to validate these findings and to explore other methods of improving patient involvement in decisions will be valuable.
References
1. http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm. Accessed August 2, 2013.
2. Feng B, et al. Physician communication regarding prostate cancer screening: Analysis of unannounced standardized patient visits. Ann Fam Med 2013;11:315-323.
3. Hall IJ, Taylor YJ. Discussions about prostate cancer screening between U.S. primary care physicians and their patients. J Gen Intern Med 2011;26:1098-1104.
4. Han PK, et al. National evidence on the use of shared decision making in prostate-specific antigen screening. Ann Fam Med 2013;11:306-314. doi:10.1370/afm.1539.
