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Patient Perspectives on the Value of Prostate Cancer Screening: A Qualitative Study
Partin MR, Burgess DJ, Chrouser K, Kinsinger L, Lillie SE, Taylor BC, White K, Wilt TJ. Patient Perspectives on the Value of Prostate Cancer Screening: A Qualitative Study. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.
To inform efforts to effectively communicate information about new prostate cancer screening evidence and recommendations to patients, we sought to characterize patient perspectives on the benefits and harms of screening, assess their reactions to the new recommendations, and develop hypotheses about variation in perspectives and reactions by race and age.
We pursued these objectives using interpretive and grounded theory analysis of 26 individual qualitative interviews conducted in June 2013 with male patients receiving care at the Minneapolis Veterans Affairs Health Care System. We recorded and transcribed all interviews, and used qualitative software (NVivo 10.0) to identify key themes and explore variation in themes by patient race and age.
Eligible participants included male Veterans age 50 to 84 without a diagnosis of prostate cancer or dementia, who attended at least one outpatient visit with a Minneapolis Veterans Affairs Health Care System primary care provider within one year prior to sample selection, who received a PSA from a Veterans Affairs medical facility within two years prior to sample selection, and who had complete address and phone information available. We stratified our study sample by age (50-69; 70-84) and race (African American; Non-African American) to facilitate comparisons. From the 11,543 patients meeting eligibility criteria, we randomly selected 150 to recruit to the individual interviews. We mailed these 150 eligible individuals a letter describing the study, and a number to call if they preferred not to be contacted about their interest in participating. We contacted Veterans who did not opt of the study within one week of the mailing, proceeding sequentially down the list of eligible individuals until we recruited a minimum of ten individuals within each strata.
We interviewed 10 African American men (eight age 50-69; two age 70-84), and 16 non-African American men (eight age 50-69; eight age 70-84). Men in all age and race groups expressed misperceptions about the benefits of prostate cancer screening. Specifically, most men expressed the belief that the main benefit is living longer, and that the likelihood of experiencing this benefit is high. Men in all age and race groups voiced difficulty understanding the connection between a simple blood test and the downstream harms of follow-up testing and treatment, but fewer African American men were able to identify possible harms of screening than non-African American men. Reactions to recommendations against screening ranged from unconditionally receptive to highly resistant in all age and race groups, but resistance was more commonly expressed in older than younger men and in non-African American than African American men. Some men who initially expressed resistance to discontinuing screening said they would accept a recommendation to discontinue from their trusted physician.
Men in all age and race groups have misperceptions about the benefits of prostate cancer screening, but perceptions about the harms of screening and reactions to recommendations to discontinue screening may vary by age and race.