PRIMARY CARE PHYSICIANS' REPORTED USE OF KEY BEHAVIORS FOR PROMOTING INFORMED DECISION MAKING ABOUT PROSTATE CANCER SCREENING

   Purpose: While current guidelines endorse informing patients about the benefits and harms of prostate cancer screening (PCS), little is known about how physicians implement these guidelines. Strategies are needed to promote implementation of informed decision making (IDM) in clinical practice.
   Methods: We identified nine IDM behaviors drawn from the major prostate cancer screening guidelines, including reports of the U.S. Preventive Services Task Force and Community Preventive Services Task Force on shared and IDM, respectively; tenets of informed consent; an Australian CME trial; constructs measured in cancer screening decision aid trials; consultation with practicing physicians and medical decision-making experts; and the “5 A’s” (Ask, Advise, Assess, Assist, Arrange Follow-up) used to structure tobacco cessation counseling. A survey of physicians’ use of the key behaviors was then conducted in the AAFP National Research Network (NRN), and was administered between July 2007 and January 2008. NRN physicians answered questions about how often they engaged in each key behavior, using 5-point Likert scales ranging from 1 “never” to 5 “always.” A general IDM practice style indicator was used to identify physicians who a) do not routinely discuss PCS, b) discuss PCS and then recommend screening, and c) discuss PCS and then let the patient decide. Differences in the frequency of key behaviors were then examined across the three practice styles.
   Results: Of 426 invited NRN members, 245 (57.5%) completed the survey. The most frequently reported key behaviors were inviting men to ask questions and letting men know that there is a decision to be made. The least commonly reported key behaviors were referring undecided men to other sources of information about screening and making plans for follow-up discussions with undecided men. There were significant differences across the three practice styles for all nine of the key behaviors (P<.05).
   Conclusions: Primary care physicians use a variety of behaviors with their patients to promote IDM for PCS, and the frequency of these behaviors differs by their reported practice style. Because clinicians report most difficulty managing undecided patients, provider-based informed decision making interventions should provide clear options for action and methods for managing undecided patients.