title: Avoidance of anticipated regret: the ordering of prostate-specific antigen tests.
abstract: OBJECTIVE
  When making decisions, people are known to try to minimize the regret that would be provoked by unwanted consequences of these decisions. The authors explored the strength and determinants of such anticipated regret in a study of physicians' decisions to order prostate-specific antigen (PSA) tests.
  
  
  METHODS
  32 US and 33 French primary care physicians indicated the likelihood they would order a PSA for 32 hypothetical men presenting for routine physical exams. They then indicated how much regret they would feel if they found advanced prostate cancer in 12 other patients for whom they had chosen not to order PSAs several years before. The latter patients differed according to age (55, 65, or 75 years), a prior request or not for PSA testing, and no or some irregularity of the prostate on the earlier rectal exam.
  
  
  RESULTS
  ANOVA found that regret was higher when the patient had requested a PSA, the prostate was irregular, and the patient was younger. Shape had less effect when the patient had requested a PSA. US physicians had more regret than the French, patient request had a greater impact on the Americans, and increasing patient age reduced regret more among the French. In a 1-way correlation, the regret score was associated with the likelihood of ordering PSAs for both the French (r = 0.64, P < 0.005) and the Americans (r = 0.42, P< 0.02). In a regression analysis too, the regret score was the most important predictor of the likelihood of ordering a PSA (beta = 0.37, P < 0.0001).
  
  
  CONCLUSIONS
  Regret over failing to diagnose aggressive prostate cancer is associated with a policy of ordering PSAs. This regret appears to be culturally sensitive.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Sorum
authors.forename: Etienne
authors.initials: E
authors.lastname: Mullet
authors.forename: Junseop
authors.initials: J
authors.lastname: Shim
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonnin-Scaon
authors.forename: Gérard
authors.initials: G
authors.lastname: Chasseigne
authors.forename: Joël
authors.initials: J
authors.lastname: Cogneau
mesh_terms: D000368:Aged; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D004644:Emotions; D005602:France; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen