title: Primary care providers' perspectives on discontinuing prostate cancer screening.
abstract: BACKGROUND
  Clinical guidelines recommend against routine prostate-specific antigen (PSA) screening for older men and for those with lower life expectancies. The authors of this report examined providers' decision-making regarding discontinuing PSA screening.
  
  
  METHODS
  A survey of primary providers from a large, university-affiliated primary care practice was administered. Providers were asked about their current screening practices, factors that influenced their decision to discontinue screening, and barriers to discontinuing screening. Bivariate and multivariable logistic regression analyses were used to examine whether taking age and/or life expectancy into account and barriers to discontinuing were associated with clinician characteristics and practice styles.
  
  
  RESULTS
  One hundred twenty-five of 141 providers (88.7%) participated in the survey. Over half (59.3%) took both age and life expectancy into account, whereas 12.2% did not consider either in their decisions to discontinue PSA screening. Providers varied in the age at which they typically stopped screening patients, and the majority (66.4%) reported difficulty in assessing life expectancy. Taking patient age and life expectancy into account was not associated with provider characteristics or practice styles. The most frequently cited barriers to discontinuing PSA screening were patient expectation (74.4%) and time constraints (66.4%). Black providers were significantly less likely than nonblack providers to endorse barriers related to time constraints and clinical uncertainty, although these results were limited by the small sample size of black providers.
  
  
  CONCLUSIONS
  Although age and life expectancy often figured prominently in decisions to use screening, providers faced multiple barriers to discontinuing routine PSA screening.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. cpollac2@jhmi.edu
authors.forename: Craig E
authors.initials: CE
authors.lastname: Pollack
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Platz
authors.forename: Nrupen A
authors.initials: NA
authors.lastname: Bhavsar
authors.forename: Gary
authors.initials: G
authors.lastname: Noronha
authors.forename: Gene E
authors.initials: GE
authors.lastname: Green
authors.forename: Sean
authors.initials: S
authors.lastname: Chen
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
mesh_terms: D000367:Age Factors; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires
chemical_list: D017430:Prostate-Specific Antigen