Tuesday, August 26, 2014

What happens when patients are informed about the evidence, especially when the evidence is not totally conclusive?

Golly, perhaps it seems silly to ask, but let's give credit to Matthew Maurice and Robert Abouassaly for doing so in a rigorous way.  A current article in Urology 84 (2), 2014, is entitled "Patient Opinions on Prostate Screening are Swayed by the United States Preventative Task Force Recommendations."

The answer, simply, is that patients think about the evidence and draw their own conclusions.  Perhaps just like doctors do.  My take:  Working in partnership and sharing information, they'll both make better decisions.

The abstract:


To survey patient opinions on prostate cancer (PCa) screening in light of the United States Preventive Services Task Force recommendation against its use.


We conducted a survey of all-comers to urology and primary care clinics. Participants provided demographic information and responded to a 5-item questionnaire regarding their opinions on screening before and after reading opposing position statements.


The overall response rate was 48%. After excluding incomplete questionnaires, 54 surveys were available for analysis. Patients were predominantly white, middle-aged and older, college-educated men with middle-to-upper-middle-class incomes who were seen at urology clinics. Patients rated their “pre” level of understanding of screening recommendations as good or very good (52%), okay (30%), and poor (19%). After reading the information sheets, good or very good understanding of screening recommendations improved (65%; P = .05), and agreement with the importance of screening remained high (80%). However, nearly 20% of patients expressed a more neutral or less favorable attitude toward the risk-benefit ratio of screening (P = .09). Agreement that men should undergo screening, that screening helps detect cancer, and that screening saves lives remained high, regardless of the exposure.


Overall, patients favor PCa screening, but heightened awareness of the current controversy raises concerns about its potential harms. PCa screening is a complex issue, and insight into changing public opinion will be crucial to our future discussions with patients who are wrestling with the decision whether to undergo screening.


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