title: Physician-patient discussions of controversial cancer screening tests.
abstract: BACKGROUND
  Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions.
  
  
  METHODS
  We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions.
  
  
  RESULTS
  For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier.
  
  
  CONCLUSIONS
  Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.
authors.affiliation: Departments of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. andrew.dunn@mssm.edu
authors.forename: A S
authors.initials: AS
authors.lastname: Dunn
authors.forename: K V
authors.initials: KV
authors.lastname: Shridharani
authors.forename: W
authors.initials: W
authors.lastname: Lou
authors.forename: J
authors.initials: J
authors.lastname: Bernstein
authors.forename: C R
authors.initials: CR
authors.lastname: Horowitz
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D003142:Communication; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008327:Mammography; D010817:Physician-Patient Relations; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000517:prevention & control*
chemical_list: D017430:Prostate-Specific Antigen