Patients Left Out Of Decision Loop On Cancer Screening
To screen or not to screen for prostate and breast cancer may be the doctor's choice alone, a study suggests.
A survey of primary care physicians at three urban New York hospitals found upwards of one-third of doctors do not discuss decisions to run these cancer screens with their patients. Reasons include lack of time, the complexity of the subject and language barriers.
"Despite the models of shared decision-making and informed consent, no one knows much about the quality or frequency of conversations in the doctor's office," says lead author Andrew S. Dunn, MD, FACP. "Our finding, that up to one-third of the physicians would not discuss the risks and benefits of such controversial tests for prostate cancer for men and breast cancer for women less than 50 years of age, raises questions about how much patients are allowed to participate in their medical care."
Researchers from the Mount Sinai Schools of Medicine and Health Policy in New York queried primary care physicians about whether they would order prostate-specific antigen (PSA) measurements or mammograms for three hypothetical patients. The physicians were also asked if the advantages of the testing outweighed the disadvantages as well as whether they would initiate a discussion with patients about the benefits and risks of the tests.
The hypothetical patients on the questionnaire were a 55-year-old male, a 45-year-old female and a 55-year-old female, with no significant medical history and normal physical exams. The 169 respondents were house staff and attending physicians, predominantly male and Caucasian.
Nearly all doctors said they would order a mammogram for the older woman. For the younger woman, 75 percent called for the screen. A little over half of the doctors said a PSA screen was appropriate for the man.
However, many of the doctors said they would make those choices independent of the patient's preference. In addition, one quarter of the physicians said such a discussion with their patients would not influence their decision to order the screen.
Doctors reported they would be more likely to discuss the mammogram with the younger woman, a screen considered more controversial.
"It also mattered, among house staff, if the doctors believed in the test and planned to order it," said Dr. Dunn. "Those who consider the PSA screening as advantageous were more likely to discuss the screening than those who considered the test to be otherwise."
The results of the study are published in the February issue of the American Journal of Preventive Medicine.
"Although we recognize that these discussions can be time-consuming and complex, we believe patients should not be inappropriately denied the opportunity to make choices when it comes to significant medical decisions," said Dr. Dunn.
The researchers recommend further study to include larger and more diverse groups of physicians.
Thanks to Doctors' Guide
J Clinical Oncology, 1/02
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Supportive Cancer Care,
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Euro Soc Med Onc, 10/02
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