title: Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study.
abstract: To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.
  
  
  
  A grounded theory study.
  
  
  
  Primary care practices in Australia and the UK.
  
  
  
  69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.
  
  
  
  GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening.
  
  
  
  The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed.
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kristen
authors.initials: K
authors.lastname: Pickles
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Stacy M
authors.initials: SM
authors.lastname: Carter
authors.affiliation: School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.
authors.forename: Lucie
authors.initials: L
authors.lastname: Rychetnik
authors.affiliation: Health Services Research Unit, University of Aberdeen, Foresterhill Aberdeen, UK.
authors.forename: Vikki A
authors.initials: VA
authors.lastname: Entwistle
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003431:Cross-Cultural Comparison; D055088:Early Detection of Cancer; D005194:Family Practice; D005260:Female; D058005:General Practitioners; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011467:Prostate; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D036301:Qualitative Research; D006113:United Kingdom; D019564:Unnecessary Procedures
chemical_list: D017430:Prostate-Specific Antigen
keywords: australia; mindlines; prostate cancer screening; prostate-specific antigen test; united kingdom