title: Unwanted control: how patients in the primary care setting decide about screening for prostate cancer.
abstract: Current guidelines recommend shared decision-making to determine whether the prostate-specific antigen (PSA) test should be performed. At a large family medicine practice in suburban Washington, DC, we administered a sequence of patient and physician surveys to examine the desired and actual level of patient control over PSA screening decisions and the circumstances in which they occur. Both before and after visits, patients expressed a preference for a shared approach to the PSA decision, but the actual decision involved a significant shift toward greater patient control. Almost 25% of patients reported greater decisional control than they desired. Fully 30% of the men who wanted a shared approach made the actual decision themselves. Patients prefer a shared approach to the PSA decision but report greater personal control when the decision is actually made. Further research is needed to understand this phenomenon and to better accommodate patients' desire for shared decision-making.
authors.affiliation: Department of Family Practice, Virginia Commonwealth University, 3712 Charles Stewart Drive, Fairfax, VA 22033, USA. swoolf@vcu.edu
authors.forename: Steven H
authors.initials: SH
authors.lastname: Woolf
authors.forename: Alex H
authors.initials: AH
authors.lastname: Krist
authors.forename: Robert E
authors.initials: RE
authors.lastname: Johnson
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Stenborg
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D005194:Family Practice / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007389:Internal-External Control; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D008960:Models, Psychological; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014768:Virginia