THE INFLUENCE OF DATA VERSUS NARRATIVES ON PROSTATE SPECIFIC ANTIGEN SCREENING DECISIONS

Purpose: Evidence indicates that PSA screening saves few or no lives and causes harm through false positives and overdiagnosis. Since 2012 the United States Preventive Services Task Force has recommended against routine PSA screening, but nonetheless, many men still receive it. An important question is how to reduce public interest in services like PSA screening, which are known to be minimally effective. One promising approach is the use of narrative stories, which can make adverse outcomes more vivid and emotionally compelling. The purpose of this study was to test whether 3 different kinds of narratives about outcomes of PSA screening can influence screening acceptance, and whether those narratives influence screening acceptance over-and-above PSA risk and benefit data.  

Method: We recruited 1208 men age 40 and older (M=56, SD=10; range=40-86, 77% white) to complete an online survey. First, participants received basic information about PSA screening and then reported whether they would get screened (yes/no). Next, participants were given detailed information about PSA screening, including pictographs depicting the number of lives it saves and the rate of false positives and overdiagnosis. Screening acceptance was then reassessed. Finally, participants were randomly assigned to 1 of 4 narrative conditions: (1) a narrative that described physical harm, (2) a narrative that described feelings of uncertainty following screening, (3) a narrative that described overdiagnosis, and (4) all 3 narratives. After this, desire for screening was assessed for a third time.

Result: After receipt of basic information, 76.8% of men wanted PSA screening, which dropped to 56.4% after the presentation of risk data, Z=-14.37, p<.001. Narratives further reduced screening acceptance to a small, but statistically significant, degree, to 52.3%, Z=-4.63, p<.001. Compared to screening acceptance just prior to the narrative, only the harm narrative and all 3 narratives together further reduced screening acceptance (both ps<.01). Neither the overdiagnosis or uncertainty narratives influenced test acceptance (both ps>.29).

Conclusion: Providing detailed information about PSA risks and benefits significantly reduced men’s interest in PSA testing. Narratives had an additional effect on test acceptance, but this effect appeared to be specific to respondents who read about physical harms associated with testing and follow-up. By contrast, uncertainty and overdiagnosis narratives had no effect on test acceptance.