Prostate-specific antigen testing among the elderly in community-based family medicine practices.
BACKGROUND
Controversy surrounds prostate-specific antigen (PSA) testing for prostate cancer screening, especially among elderly men aged 75 and older. This study examines whether patient age results in differential use of PSA testing and if organizational attributes such as communication, stress, decision making, and practice history of change predict PSA testing among men aged 75 and older.


METHODS
Data came from chart audits of 1149 men > or =50 years old who were patients of 46 family medicine practices participating in 2 northeastern practice-based research networks. Surveys administered to clinicians and staff in each practice provide practice-level data. A stratified Cochran-Mantel-Haenszel test was applied to examine whether PSA testing decreased with age. Hierarchical logistic regression analyses determined characteristics associated with PSA testing for men > or =75 years old.


RESULTS
Comparable rates for annual PSA testing of 77.2% for men aged 50 to 74 years and 74.6% for men > or =75 years old were reported. The Cochran-Mantel-Haenszel test indicated no significant change in trend. Hierarchical models suggest that practice communication is the only organizational attribute that influences PSA testing for men 75 years of age or older (odds ratio, 5.04; P = .022). Practices with higher communication scores (eg, promoted constructive work relationships and a team atmosphere between staff and clinicians) screened men aged 75 and older at lower rates than others.


CONCLUSIONS
Elderly men in community settings receive PSA testing at rates comparable to their younger counterparts even though major clinical practice guidelines discourage the practice for this population. Intraoffice practice interventions that target PSA testing to the most appropriate populations and focus on communication (both within the office and with patients) are needed.
Hudson
Shawna V
SV
The Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903-2681, USA. hudsonsh@umdnj.edu
Ohman-Strickland
Pamela
P
Ferrante
Jeanne M
JM
Lu-Yao
Grace
G
Orzano
A John
AJ
Crabtree
Benjamin F
BF
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D055088:Early Detection of Cancer; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008485:Medical Audit; D008875:Middle Aged; D009511:New England; D010821:Physicians, Family / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*
D017430:Prostate-Specific Antigen