Prostate Cancer Screening Practices and Knowledge of Prostate Cancer Screening Clinical Practice Guidelines By Primary Care Physicians: A Systematic Review of the Literature and Original Research Design
Creators: name: Wedlake, Tiffany
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2009

description: Objectives: The purpose of this paper is to systematically examine the literature regarding primary care physicians' knowledge and practice style concerning prostate cancer screening. I will then use the information to develop a research plan to assess physician practice styles, beliefs, and knowledge of recent guidelines and scientific evidence regarding prostate cancer screening. Methods: I conducted a systematic evidence review to determine whether American primary care physicians are using shared decision-making when doing prostate cancer screening and which clinical practice guidelines (CPGs) they are aware of. I used a Medline search. Cross-sectional studies were included in the review. Randomized controlled trials, cohort studies and case-control studies would have been accepted except none were found. The main outcomes of interest were physicians' prostate cancer screening style specifically if they do pretest counseling (including shared decision-making), and knowledge of prostate cancer screening guidelines. Shared decision-making was defined as physicians doing prescreening discussions of the risks and benefits of prostate cancer screening and allowing their patients to participate in the decision whether or not to proceed with screening to the level the patient desired. Results: Seven studies were included in the final review, none were done since the most recent guideline updates issued in 2008 and 2009 and none looked at knowledge of recent evidence from two large randomized controlled trials (RCT) on mortality benefit of PSA screening that were published in March of 2009. Several themes emerged from the literature review of studies published since 2000. It showed that between 60% and I 00% of physicians report using shared decision-making. The 100% was from a focus group study, whereas in surveys between 66% and 99% of physicians report using shared decision-making. Physicians with knowledge of the guidelines or the unclear evidence of benefit are more likely to use shared decision-making than those without the knowledge. And between 0% and 33% of men age 50 and over are being screened for prostate cancer without a prescreening discussion of risks and benefits. No studies compared knowledge of guidelines to practice style. Conclusion: Primary care physicians with greater knowledge of the insufficient evidence for prostate cancer screening are more likely than those lacking knowledge to be practicing shared decision-making. Since all of the studies were done prior to 2009, it is not clear whether physicians have knowledge of the newest CPGs and randomized-control trial evidence for prostate cancer screening. Yet, the results of this review show that knowledge of the latest developments is likely to influence practice. Our research study is designed to assess the knowledge of the newest evidence and guidelines and the effect this has had on physician belief of benefit of prostate cancer screening. The primary outcomes will be knowledge of the mortality studies and current guideline, reported influence of the 2009 RCTs of prostate cancer screening on practice style, any association between knowledge of the RCTs or guidelines and belief of benefit of prostate cancer screening, and any association between knowledge of the mortality studies on practice style. We will also assess the way physicians report learning about the RCTs and any association between reported knowledge and correct knowledge answers with method of learning about the RCTs.