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Prostate Cancer Screening Among Primary Care Providers: A Shift in Practice Patterns Since 2012
Jennifer K Yates1, Andrew Leone2, Roger Luckmann1, Joseph Brito2, Achankeng Afiadata1, Jennifer Fantasia1, Daniel Frendl1, Mitchell Sokoloff1, Joseph Renzulli2
1University of Massachusetts, Worcester, MA;2Warren Alpert Medical School, Brown University, Providence, RI
Provider utilization of PSA as a screening tool for prostate cancer has changed since the United States Preventive Services Task Force (USPSTF) statement in 2012.
This survey of PCP’s associated with two health care systems will help to define the impact of the USPSTF statement on PCP delivery of care and identify areas of educational opportunity.
A survey composed of 25 questions was mailed electronically to PCP’s within two academic health care systems. Providers included both hospital-employed and hospital-affiliated PCPs. The responses could not be traced to the respondent.
Eighty-six PCP’s responded to the survey, including 48% female providers and 52% male providers. The majority of respondents were MD/DO providers. Regarding familiarity with the 2012 USPSTF statement, 97% were somewhat or very familiar with the statement, and 75% had changed their practice patterns. Table 1 lists the responses of the survey participants to select questions.
This survey, while limited to two large academic centers, identifies changes in screening practices since the USPSTF 2012 statement. There is clearly a need for more educational opportunities for PCP’s in regards to the USPSTF statement and the AUA guidelines.
|Which of the following statements about the USPSTF statement on prostate cancer screening from May 2012 is true (Check ALL that apply)||Advises against all routine PSA screening (N=42)|
Advises against the use of PSA testing for following patients with known prostate cancer (treated or untreated).
Recommends that providers engage men of the appropriate age in shared decision making about PSA screening, and that that they order a PSA test for men who request one after engaging in shared decision making. (N=51)
|PSA mortality has decreased over the past two decades. To what extent do you believe that this can be explained by PSA screening?||PSA screening is at least partially responsible for this decrease (37%)|
PSA screening likely played no role in this decrease (31%)
Not sure (32%)
|Is the following statement true? “The USPSTF statement specifically recommends against digital rectal exam (DRE) in asymptomatic men for prostate cancer screening.”||Yes (41%)|
Not sure (19%)
|The USPSTF statement claims that based on existing evidence, the routine use of screening PSA may impart more harm than benefit to the patient. To what extent do you agree or disagree with this claim?||Strongly disagree (1%)|
No opinion (14%)
Strongly Agree (21%)
|How did your practice change? (Check all that apply) (*after the 2012 USPSTF Statement)||I went from routinely recommending PSA screening to recommending against PSA screening (N=7)|
I went from a neutral stance on PSA screening (neither for or against) to recommending against PSA screening (N=9)
I went from routinely recommending PSA screening to engaging patients in a shared decision making process and allowing patients to decide (N=38)
I went from routinely discussing PSA testing with my patients to discussing it ONLY if the patient brings it up (N=8)
|How concerned are you that NOT routinely recommending PSA screening to patients of appropriate age could lead to future litigation regarding failure to diagnosis early prostate cancer||(Responses on continuum from 1 to 5):|
1. Not at all concerned (14%) ---2. (27%) --- 3. (34%) ---4. 16% --- 5. Very concerned (9%)
|How concerned are you that routinely recommending PSA screening to patients of appropriate age could lead to future litigation regarding OVERdiagnosis early prostate cancer?||(Responses on continuum from 1 to 5):|
1. Not at all concerned (36%) ---2. (34%) --- 3. (22%) ---4. (3%) --- 5. Very concerned (5%)
|Do you routinely recommend a periodic digital rectal exam (DRE) of the prostate to asymptomatic patients that you consider of the appropriate age for prostate cancer screening?||Yes 42.42%|
|Has the USPSTF statement on prostate cancer screening in 2012 changed your practice of recommending DRE?||Yes, I recommend DRE more often (3%)|
Yes, I recommend DRE less often (35%)
No, I have not changed my practice (62%)
|Do you feel that there is a need for more education of primary care providers regarding PSA screening, including topics such the evidence for and against screening, benefits and harms of screening, approaches to shared decision making, and others.||Yes (83%)|
Not sure (10%)
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