The importance of patient preference in the decision to screen for prostate cancer. Prostate Patient Outcomes Research Team.
OBJECTIVE
Routine screening for prostate cancer is controversial because of frequent false-positive results, the potential for slow, non-life-threatening growth of untreated cancer, the uncertainty regarding whether treatment can extend life, and the potential for treatment complications. This study examines how information about prostate-specific antigen (PSA) testing and the uncertain benefits of treating prostate cancer affects patients' desire for PSA testing.


METHODS
An educational videotape designed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was presented to two groups of male patients 50 years of age or older.


METHODS
Dartmouth-Hitchcock Medical Center.


METHODS
For study 1, men seeking a free prostate cancer screening were preassigned to view the educational videotape (N = 184) or another videotape (N = 185). For study 2, men scheduled to visit a general internal medicine clinic viewed either the educational videotape (N = 103) or no videotape (N = 93).


RESULTS
The men's information and preferences about prostate cancer screening and treatment and actual choice of PSA test at the next test opportunity were measured. Men who viewed the educational videotape were: better informed about PSA tests, prostate cancer, and its treatment; preferred no active treatment if cancer were found; and preferred not to be screened (all significant at p < or = .002 in both studies). Men viewing the educational video were less likely to have a PSA test (p = .041, study 2). This tendency was not significant at the free-PSA clinic (p = .079).


CONCLUSIONS
Preference regarding cancer screening and treatment is greatly affected by information about medical uncertainties. Because informed patient choices vary. PSA screening decisions should incorporate individual preferences.
Flood
A B
AB
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755-3863, USA.
Wennberg
J E
JE
Nease
R F
RF
Fowler
F J
FJ
Ding
J
J
Hynes
L M
LM
D016022:Case-Control Studies; D003657:Decision Making; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D011795:Surveys and Questionnaires; D014481:United States; D014743:Videotape Recording
D017430:Prostate-Specific Antigen