This article is more than 5 years old. Information may no longer be current.
PCPs in need of clinical decision-making tool for deciding to cease PSA testing in patients
Click Here to Manage Email Alerts
Primary care providers reported facing multiple barriers to discontinuing routine PSA screening, as well as difficulty knowing when to take age and life expectancy into account with regard to this decision, according to a recently published study.
In October 2011, the US Preventive Services Task Force issued a draft recommendation that discouraged the routine use of PSA screening for all healthy men regardless of age. Task force members — who issued a final version of that draft recommendation in May — concluded the potential harms of screening may outweigh potential benefits.
To examine whether PCPs were adapting to the draft recommendations, researchers surveyed physicians at Johns Hopkins Community Physicians, a practice with 26 outpatient sites. They distributed a self-administered survey to 141 individuals that asked physicians about their screening practices, factors that influenced their decisions to cease screening, and barriers to discontinuation of screening.
Source: Pollack CE
The researchers received responses from 125 (88.7%) of physicians. More than 60% of these physicians were women, and about 12% were black.
When asked about the age at which they recommended discontinuing screening, 32.5% of physicians said they had no such benchmark. Of those who did have a specific age when they ceased recommending screening, 26.8% used age less than or equal to 70 years; 52.4% used 75 years; and 20.7% used age 80 years or older.
Although a majority of providers said they took life expectancy into account when deciding to stop recommending screening, 66.4% of them said they had difficulty estimating life expectancy.
The most frequently identified barriers to ceasing screening were patient expectation of screening (74.4%) and a lack of time to explain the recommendation to cease screening (66.4%).
“The current results suggest that, for some providers, there is a lack of agreement over the age at which to discontinue testing, and they reported difficulty in assessing life expectancy,” the researchers wrote. “For providers [who] already consider these factors, the development of tools that help clinicians more accurately and quickly estimate life expectancy may be an important next step.”
Reference:
- Pollack CE. Cancer. 2012;doi10.1002/cncr.27577.
Perspective
Back to Top
Donald L. Trump, MD, FACP
Pollack and colleagues report an interesting and important study seeking to determine the factors important in discontinuing PSA screening among primary care physicians. The results emphasize the complexity of this issue — the most frequently cited barriers to discontinuing PSA screening were patient expectation to be screened and the time required to explain the question of discontinuing. The trial, although relatively small, is important. It is critical to continue studies of this type to delineate the factors that influence the application — or not — of the US Preventive Services Task Force recommendation regarding PSA screening.
Click Here to Manage Email Alerts