title: Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.
abstract: BACKGROUND
  Shared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.
  
  
  OBJECTIVE
  In July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.
  
  
  METHODS
  Two-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.
  
  
  METHODS
  Sixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).
  
  
  METHODS
  Panelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.
  
  
  RESULTS
  Highly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.
  
  
  CONCLUSIONS
  Conference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers.
authors: University of California, Davis School of Medicine, 1 Shield Avenue, Sacramento, CA, USA, mswilkes@ucdavis.edu.
authors: Michael
authors: M
authors: Wilkes
authors: Malathi
authors: M
authors: Srinivasan
authors: Galen
authors: G
authors: Cole
authors: Richard
authors: R
authors: Tardif
authors: Lisa C
authors: LC
authors: Richardson
authors: Marcus
authors: M
authors: Plescia
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010358:Patient Participation / Q000379:methods; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D035501:Uncertainty
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