title: Physician communication regarding prostate cancer screening: analysis of unannounced standardized patient visits.
abstract: OBJECTIVE
  Prostate cancer screening with prostate-specific antigen (PSA) is a controversial issue. The present study aimed to explore physician behaviors during an unannounced standardized patient encounter that was part of a randomized controlled trial to educate physicians using a prostate cancer screening, interactive, Web-based module.
  
  
  METHODS
  Participants included 118 internal medicine and family medicine physicians from 5 health systems in California, in 2007-2008. Control physicians received usual education about prostate cancer screening (brochures from the Center for Disease Control and Prevention). Intervention physicians participated in the prostate cancer screening module. Within 3 months, all physicians saw unannounced standardized patients who prompted prostate cancer screening discussions in clinic. The encounter was audio-recorded, and the recordings were transcribed. Authors analyzed physician behaviors around screening: (1) engagement after prompting, (2) degree of shared decision making, and (3) final recommendations for prostate cancer screening.
  
  
  RESULTS
  After prompting, 90% of physicians discussed prostate cancer screening. In comparison with control physicians, intervention physicians showed somewhat more shared decision making behaviors (intervention 14 items vs control 11 items, P <.05), were more likely to mention no screening as an option (intervention 63% vs control 26%, P <.05), to encourage patients to consider different screening options (intervention 62% vs control 39%, P <.05) and seeking input from others (intervention 25% vs control 7%, P<.05).
  
  
  CONCLUSIONS
  A brief Web-based interactive educational intervention can improve shared decision making, neutrality in recommendation, and reduce PSA test ordering. Engaging patients in discussion of the uses and limitations of tests with uncertain value can decrease utilization of the tests.
authors.affiliation: Department of Communication, University of California, Davis, Davis, CA 95616, USA. bfeng@ucdavis.edu
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.forename: Malathi
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Hoffman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Rainwater
authors.forename: Erin
authors.initials: E
authors.lastname: Griffin
authors.forename: Marko
authors.initials: M
authors.lastname: Dragojevic
authors.forename: Frank C
authors.initials: FC
authors.lastname: Day
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wilkes
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D062526:Patient Navigation / Q000379:methods*; D010817:Physician-Patient Relations; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D014481:United States / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: health communication; medical education; patient-centered care; primary care; prostate cancer; prostate cancer screening; qualitative analysis; randomized controlled trial; risk-benefit assessment; shared decision making; unannounced standardized patients