Physicians' attitudes about shared decision making for prostate cancer screening.

BACKGROUND AND OBJECTIVES Shared decision making (SDM) for prostate cancer screening (PCS) is recommended for physicians and patients due to the uncertainty regarding the risks and benefits of screening. METHODS We assessed primary care physicians' attitudes and specific factors that may influence the SDM process, including level of training and practice setting. Participants included academic clinicians (n=16), interns/residents (n=84) and community clinicians (n=35). Physicians completed a 26-item survey that assessed attitudes about the SDM process for PCS. RESULTS More physicians endorsed SDM (47.4%) or the patient deciding (35.6%), while few physicians wanted to decide for their patients about screening. However, 54.8% endorsed an annual PSA as the standard of care. Most felt that decisions should be based on full disclosure of the risks and benefits of testing (93.3%), and few believed that the sensitivity and specificity of the PSA was adequate (36.6%). Across all physicians, lack of time, competing health demands, malpractice fears, and patient interest were all commonly cited as potential factors that influence the SDM process. Compared to academic clinicians and interns/residents, community clinicians were more likely to endorse annual screening, to be concerned about malpractice, and to agree that PSA sensitivity and specificity are acceptable. CONCLUSIONS Our findings demonstrate physician, patient and systemic factors regarding the PCS decision. Further effort is needed to overcome the barriers of engaging patients in SDM if we want to truly promote effective SDM for PCS, as espoused by national guidelines.