Men's reactions to disclosed and undisclosed opportunistic PSA screening for prostate cancer.
OBJECTIVE
To assess the degree to which men considered it appropriate for general practitioners to order prostate-specific antigen (PSA) testing if the testing was either "disclosed" or "undisclosed" to the patient.


METHODS
Telephone-administered survey conducted in June to October 2000.


METHODS
514 men aged 50-70 years, identified by random selection of households from the Sydney Electronic White Pages phone directory.


METHODS
We developed two hypothetical scenarios. Each scenario described a GP ordering a PSA test for a male patient at the same time as other pathology tests were ordered. In Scenario 1, the GP's intention to order a PSA test was disclosed to the patient ("disclosed"). In Scenario 2, the GP did not tell the patient a PSA test was being ordered ("undisclosed"). For each scenario, men reported the degree to which they perceived screening to be "appropriate". We also recorded demographic characteristics, health status and health locus of control, and administered a 14-question knowledge test about prostate cancer and PSA screening.


RESULTS
Over 90% of men stated that "disclosed" PSA screening was either "appropriate" or "very appropriate". Significantly fewer (44.9%) rated "undisclosed" screening as appropriate/very appropriate (P < 0.001). While the skewed distribution of responses to Scenario 1 precluded multivariate analysis to determine predictors, men rejecting "undisclosed" PSA screening (Scenario 2) were more likely to be younger (adjusted odds ratio [AOR], 0.97; 95% CI, 0.94-1.00; P = 0.03); to have better knowledge of the issues (AOR, 1.01; 95% CI, 1.00-1.03; P = 0.02); and to be single (AOR, 0.62; 95% CI, 0.41-0.94; P = 0.02).


CONCLUSIONS
Many men consider that inclusion of PSA screening within a battery of pathology tests without disclosure to the patient is unacceptable. Educating men about the pros and cons of screening may alter their support of opportunistic screening and thus enhance community expectations of "informed participation".
Gattellari
Melina
M
School of Public Health and Community Medicine, University of New South Wales, Locked Bag 7008, Liverpool, NSW 1871, Australia. Melina.Gattellari@swsahs.nsw.gov.au
Ward
Jeanette E
JE
D000368:Aged; D001294:Attitude to Health; D014408:Biomarkers, Tumor / Q000097:blood*; D005194:Family Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D009517:New South Wales; D010817:Physician-Patient Relations; D017430:Prostate-Specific Antigen / Q000097:blood*; D014342:Truth Disclosure
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen