« Previous Next »American Journal of Preventive Medicine
Volume 20, Issue 2 , Pages 130-134, February 2001

Physician–patient discussions of controversial cancer screening tests¹

Presented in part at the Society of General Internal Medicine Annual National Meeting, April 29 to May 1, 1999, San Francisco, California.

Andrew S Dunn, MD
- Departments of Medicine (Dunn, Shridharani, Horowitz, Bernstein), Mount Sinai School of Medicine, New York, New York, USA
- Address correspondence and reprint requests to: Andrew Dunn, MD, 1470 Madison Ave, Box 1087, Mount Sinai Medical Center, New York, NY 10029
Kanan V Shridharani, MD
- Departments of Medicine (Dunn, Shridharani, Horowitz, Bernstein), Mount Sinai School of Medicine, New York, New York, USA
Wendy Lou, PhD
- Biomathematical Sciences (Lou), Mount Sinai School of Medicine, New York, New York, USA
Jeffrey Bernstein, MD
- Departments of Medicine (Dunn, Shridharani, Horowitz, Bernstein), Mount Sinai School of Medicine, New York, New York, USA
Carol R Horowitz, MD, MPH
- Departments of Medicine (Dunn, Shridharani, Horowitz, Bernstein), Mount Sinai School of Medicine, New York, New York, USA
- Health Policy (Horowitz), Mount Sinai School of Medicine, New York, New York, USA

Abstract

Background: Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions.

Methods: We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians’ likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions.

Results: For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians’ belief that PSA screening is advantageous; house staff and attending physicians’ intention to order a PSA test, and attending physicians’ intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier.

Conclusions: Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians’ beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.

Keywords: mammography, mass screening, physician–patient relations, prostate-specific antigen