Abstract
Purpose: Since prostate-specific antigen (PSA) screening is controversial, some authorities
recommend that patients give informed consent before testing. We identified and compared
what facts experts and patients thought men should know.
Subjects and Methods: We recruited a Delphi panel of national experts (6 urologists
and 6 non-urologists) and conducted 6 focus groups of couples (48 subjects) with 24
screened and unscreened men from a university hospital. We ranked key facts that experts
and couples thought men ought to know before consenting to PSA screening and conducted
a multidisciplinary focus group to help interpret the findings.
Results: All participants would disclose that false positive and false negative results
can occur and that it is not known whether PSA screening reduces prostate cancer mortality.
The 12 experts would disclose the uncertain benefits of treating early, localized
prostate cancer. All 24 couples would disclose that the PSA test is a blood test and
that patients may worry about results. The 6 urologists would disclose that prostate
cancer is often incurable when symptoms appear; the 6 non-urologists, that it can
be asymptomatic. The 12 couples with screened men would disclose that the PSA test
can detect cancer sooner than the digital rectal examination; the 12 couples with
unscreened men, that PSA testing is controversial.
Conclusions: Physicians and patients agree upon some facts that men should know about
PSA screening before giving informed consent. However, physicians fail to emphasize
other facts that patients find important. Physicians may differ by expertise; patients,
by experience. Our findings provide content for informed consent for PSA screening,
and our method may be useful for other controversial tests.
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Article info
Publication history
Published online: August 16, 2004
Accepted:
May 12,
1998
Received in revised form:
May 12,
1998
Footnotes
☆Dr. Chan was supported by Institutional Training Grant Award #1T32PE10017-01 from the Bureau of Health Professions of the Health Resources and Services Administration, US Public Health Service.
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