Classifying the Reasons Men Consider to be Important in Prostate-Specific Antigen (PSA) Testing Decisions: Evaluating Ri
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ORIGINAL ARTICLE
Classifying the Reasons Men Consider to be Important in Prostate-Specific Antigen (PSA) Testing Decisions: Evaluating Risks, Lay Beliefs, and Informed Decisions Michelle E. McDowell, Ph.D & Stefano Occhipinti, Ph.D & Suzanne K. Chambers, Ph.D
# The Society of Behavioral Medicine 2013
Abstract Background Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostatespecific antigen (PSA) test. Purpose This study aims to identify classes of reasons guiding men’s decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour. Methods First-degree relatives of men with prostate cancer (n=207) and men from the general population (n=239) of Australia listed reasons they considered when deciding whether to have a PSA test. Results Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower
M. E. McDowell (*) : S. Occhipinti Griffith Health Institute, School of Applied Psychology, Griffith University, Mount Gravatt, QLD 4111, Australia e-mail: [email protected] S. Occhipinti e-mail: [email protected] M. E. McDowell : S. Occhipinti : S. K. Chambers Behavioural Basis of Health, Griffith Health Institute, Griffith University, Mount Gravatt, QLD, Australia S. K. Chambers e-mail: [email protected] S. K. Chambers Centre for Clinical Research, University of Queensland, St Lucia, QLD, Australia
proportion of men who had had a PSA test and greater proportions of highly educated and married men. Conclusion Understanding the reasons underlying men’s screening decisions may lead to a more effective information provision and decision support. Keywords PSA test . Family history . Decision making Prostate cancer is the most frequently diagnosed cancer in men worldwide [1], and the high incidence of prostate cancer has been attributed in part to the early and increased detection of cancers through prostate-specific antigen (PSA) testing [2]. Although recent evidence suggests that screening is associated with a reduction in mortality (∼20 %), there are also a number of risks such as the overdiagnosis and overtreatment of screen-detected cancers [3, 4]. In this view, the US Preventive Services Task Force recently updated its recommendation statement on screening for prostate cancer to recommend against early detection screening on the basis that the potential harms outweigh the possible benefits [5]. These formal recommendations differ to those of other health groups and authorities who advocate for individualised informed decision making where patients consider information about the risks and benefits of screening and treatment outcomes, as well as their personal values [6, 7]. However, screening decisions of
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