Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study
Objectives Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is vari...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/4/e073415.full |
| _version_ | 1797837322085990400 |
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| author | Eric Bohm Alexander Singer Sarah Kirby Roger Suss S Michelle Driedger Ryan Maier Laurel Thorlacius Jeffery W Saranchuk |
| author_facet | Eric Bohm Alexander Singer Sarah Kirby Roger Suss S Michelle Driedger Ryan Maier Laurel Thorlacius Jeffery W Saranchuk |
| author_sort | Eric Bohm |
| collection | DOAJ |
| description | Objectives Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is variability in how family physicians (FPs) approach PSA testing in asymptomatic men. The purpose of our study was to explore how family FPs approach discussions with their male patients around PSA testing in Manitoba, Canada.Design Qualitative descriptive study.Setting and participants High-ordering and median-ordering FPs were invited to participate in an interview. In addition to exploring practice behaviours around PSA testing, participants were asked to elaborate on their typical discussion with asymptomatic men who request a PSA test or other tests and procedures that they do not feel are clinically warranted. Data were analysed inductively using a constant-comparison approach.Results There were important variations between high-ordering and median-ordering FP’s approaches to discussing PSA testing. Strategies to facilitate conversations were more frequently identified by median-ordering physicians and often included methods to facilitate assessing their patient’s understanding and values. In addition to decision aids, median-ordering FPs used motivational interviewing to tailor a discussion, organised their practice structure and workflow habits in a way that enhanced patient–provider discussions and leveraged ‘new’ evidence and other aids to guide conversations with men.Conclusion We found that high-ordering FPs tended to use the PSA test for screening asymptomatic men with limited shared decision-making. Median-ordering FPs used conversational strategies that emphasised uncertainty of benefit and potential risk and did not present the test as a recommendation. |
| first_indexed | 2024-04-09T15:22:51Z |
| format | Article |
| id | doaj.art-aad8c0876b3441cc9ba73486976e57a5 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-09T15:22:51Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-aad8c0876b3441cc9ba73486976e57a52023-04-29T04:30:07ZengBMJ Publishing GroupBMJ Open2044-60552023-04-0113410.1136/bmjopen-2023-073415Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative studyEric Bohm0Alexander Singer1Sarah Kirby2Roger Suss3S Michelle Driedger4Ryan Maier5Laurel Thorlacius6Jeffery W Saranchuk7Department of Surgery, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canadaassociate professorDepartment of Psychology, University of Southampton, Southampton, UKDepartment of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Pathology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaObjectives Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is variability in how family physicians (FPs) approach PSA testing in asymptomatic men. The purpose of our study was to explore how family FPs approach discussions with their male patients around PSA testing in Manitoba, Canada.Design Qualitative descriptive study.Setting and participants High-ordering and median-ordering FPs were invited to participate in an interview. In addition to exploring practice behaviours around PSA testing, participants were asked to elaborate on their typical discussion with asymptomatic men who request a PSA test or other tests and procedures that they do not feel are clinically warranted. Data were analysed inductively using a constant-comparison approach.Results There were important variations between high-ordering and median-ordering FP’s approaches to discussing PSA testing. Strategies to facilitate conversations were more frequently identified by median-ordering physicians and often included methods to facilitate assessing their patient’s understanding and values. In addition to decision aids, median-ordering FPs used motivational interviewing to tailor a discussion, organised their practice structure and workflow habits in a way that enhanced patient–provider discussions and leveraged ‘new’ evidence and other aids to guide conversations with men.Conclusion We found that high-ordering FPs tended to use the PSA test for screening asymptomatic men with limited shared decision-making. Median-ordering FPs used conversational strategies that emphasised uncertainty of benefit and potential risk and did not present the test as a recommendation.https://bmjopen.bmj.com/content/13/4/e073415.full |
| spellingShingle | Eric Bohm Alexander Singer Sarah Kirby Roger Suss S Michelle Driedger Ryan Maier Laurel Thorlacius Jeffery W Saranchuk Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study BMJ Open |
| title | Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study |
| title_full | Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study |
| title_fullStr | Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study |
| title_full_unstemmed | Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study |
| title_short | Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study |
| title_sort | strategies used in managing conversations about prostate specific antigen psa testing among family physicians fps a qualitative study |
| url | https://bmjopen.bmj.com/content/13/4/e073415.full |
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