title: [Early detection of prostate cancer by PSA testing: the results of a qualitative study on barriers caused by physicians in Austria implementing informed decision making].
abstract: OBJECTIVE
  In the context of the Austrian Periodic Health Examination and on the basis of current evidence based medicine a systematic screening for prostate-specific antigen (PSA) is inadvisable. General practitioners (GPs) are expected to inform their patients about risks and benefits of screening before undergoing a PSA test. Ideally, this information corresponds to the model of informed decision making (IDM).The aim of this qualitative pilot-study is to explore factors, which gain insight into GPs' practice of counselling about the PSA test.
  
  
  METHODS
  This qualitative pilot study involves 5 focus groups with 30 GPs and 4 internists and in-depth interviews with 8 GPs. Both the discussions and the interviews were audio-taped, transcribed verbatim, and qualitatively analysed. Data were analysed by using typological analysis and qualitative content analysis as methodological approaches and by means of the software MAXqda.
  
  
  RESULTS
  The results of the in-depth interviews show 2 groups of GPs which can be classified by frequency of performing a PSA test: (i) routine screeners, who recommend PSA testing to all patients of 50 years and older, and (ii) non-routine screeners, who inform the patients only if they formally wish it. In-depth interviews as well as focus groups reveal that risks and adverse effects are rarely reported in GP counselling. More often they discuss the potential benefit of the testing. They regard balanced information as unacceptable for both the GP and the patient. Influencing factors concerning the patient (cognitive and emotional demand, preference of the authoritarian doctor, discouraging), factors concerning the GP (own belief in the efficacy of PSA screening, lack of knowledge) and structural factors (lack of time, lack of remuneration) were detected.
  
  
  CONCLUSIONS
  The results indicate a selective presentation of aspects of screening for prostate cancer within the GP practice of counselling, which seem to overvalue the benefits of the screening and undervalue the associated risks of the PSA test. It should be made clear that the aim - the implementation of informed decision making (IDM) within the context of counselling about PSA test - within the Austrian Periodic Health Examination has not yet been put into practice. Results show that it is necessary to improve GPs' practice of communication, for example, by integrating IDM into the context of GPs' continuous training.
authors: Institut für Gesundheitsförderung und Prävention, Graz, Österreich. gerlinde.malli@uni-graz.at
authors: G
authors: G
authors: Malli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001317:Austria / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000097:blood*; D003657:Decision Making; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen