Objective: To assess the content of counseling about prostate-specific antigen (PSA) screening. Guidelines recommend informed consent before screening because of concerns about benefits versus risks. As part of the professional practice standard for informed consent, clinicians should include content customarily provided by experts. Methods: 40 transcripts of conversations between medicine residents and standardized patients were abstracted using an instrument derived from an expert Delphi panel that ranked 10 "facts that experts believe men ought to know.". Results: Transcripts contained definite criteria for an average of 1.7 facts, and either definite or partial criteria for 5.1 facts. Second- and third-year residents presented more facts than interns (p = 0.01). The most common facts were "false positive PSA tests can occur" and "use of the PSA test as a screening test is controversial." There was an r = 0.88 correlation between inclusion by residents and the experts' ranking. Conclusion: Counseling varied but most transcripts included some expert-recommended facts. The absence of other facts could be a quality deficit or an effort to prioritize messages and lessen cognitive demands on the patient. Practice implications: Clinicians should adapt counseling for each patient, but our abstraction approach may help to assess the quality of informed consent over larger populations.
Bibliographical noteFunding Information:
The authors are grateful to Dr. Stephen Huot and to the faculty and residents of the Yale University Primary Care Internal Medicine Residency Program. Dr. Farrell is supported in part by grants K01HL072530 and R01HL086691 from the National Heart, Lung, and Blood Institute . There are no personal or other relationships with other people or organizations that could inappropriately influence, or be perceived to influence, this research.
- Doctor-patient relationship
- Informed consent
- Prostate-specific antigen
- Risk counseling