title: Clinicians' perceptions of the benefits and harms of prostate and colorectal cancer screening.
abstract: Clinicians' perceptions of screening benefits and harms influence their recommendations, which in turn shape patients' screening decisions. We sought to understand clinicians' perceptions of the benefits and harms of cancer screening by comparing 2 screening tests that differ in their balance of potential benefits to harms: colonoscopy, which results in net benefit for many adults, and prostate-specific antigen (PSA) testing, which may do more harm than good.
  
  
  
  In this cross-sectional study, 126 clinicians at 24 family/internal medicine practices completed surveys in which they listed and rated the magnitude of colonoscopy and PSA testing benefits and harms for a hypothetical 70-year-old male patient and then estimated the likelihood that these tests would cause harm and lengthen the life of 100 similar men in the next 10 years. We tested the hypothesis that the availability heuristic would explain the association of screening test to perceived likelihood of benefit/harm and a competing hypothesis that clinicians' gist of screening tests as good or bad would mediate this association.
  
  
  
  Clinicians perceived PSA testing to have a greater likelihood of harm and a lower likelihood of lengthening life relative to colonoscopy. Consistent with our gist hypothesis, these associations were mediated by clinicians' gist of screening (balance of perceived benefits to perceived harms).
  
  
  
  Generalizability beyond academic clinicians remains to be established.
  
  
  
  Targeting clinicians' gist of screening, for example through graphical displays that allow clinicians to make gist-based relative magnitude comparisons, may influence their risk perception and possibly reduce overrecommendation of screening.
authors: Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB)|Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)
authors: Emily A
authors: EA
authors: Elstad
authors: Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)
authors: Anne
authors: A
authors: Sutkowi-Hemstreet
authors: Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)|Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC (SLS, MV)|Health Care and Prevention Program, University of North Carolina, Chapel Hill, NC (SLS, RH)|Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC (SLS, RH)
authors: Stacey L
authors: SL
authors: Sheridan
authors: Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)|Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC (SLS, MV)
authors: Maihan
authors: M
authors: Vu
authors: Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)|Health Care and Prevention Program, University of North Carolina, Chapel Hill, NC (SLS, RH)|Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC (SLS, RH)
authors: Russell
authors: R
authors: Harris
authors: College of Human Ecology, Cornell University, Ithaca, NY (VFR)
authors: Valerie F
authors: VF
authors: Reyna
authors: Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB)|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (CR, NTB)
authors: Christine
authors: C
authors: Rini
authors: Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB)
authors: Jo Anne
authors: JA
authors: Earp
authors: Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB)|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (CR, NTB)
authors: Noel T
authors: NT
authors: Brewer
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003113:Colonoscopy / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D018592:Cross-Over Studies; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology; D005260:Female; D040261:Harm Reduction; D000066506:Heuristics; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010465:Perception; D010820:Physicians / Q000523:psychology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*
chemical_list: D017430:Prostate-Specific Antigen
keywords: PSA test; clinicians; colonoscopy; colorectal cancer screening; prostate cancer screening; risk perception