How underlying patient beliefs can affect physician-patient communication about prostate-specific antigen testing.

CONTEXT: Routine cancer screening with prostate-specific antigen (PSA) is controversial, and practice guidelines recommend that men be counseled about its risks and benefits. OBJECTIVE: To evaluate the process of decision making as men react to and use information after PSA counseling. DESIGN: Written surveys and semistructured qualitative interviews before and after a neutral PSA counseling intervention. PARTICIPANTS: Men 40 to 65 years of age in southeastern Michigan were recruited until thematic saturation--that is, the point at which no new themes emerged in interviews (n = 40). RESULTS: In a paper survey, 37 of 40 participants (93%) said that they interpreted the counseled information as unfavorable toward PSA. However, 30 participants (75%) said after the intervention that they intended to be tested in the future, including 29 of 30 men (97%) with prior PSA testing. In the interview, many participants cited underlying beliefs as a reason to dismiss the counseled information. Qualitative analysis found the seven most common beliefs cited were fear of cancer, relevance of salient anecdotes and analogies, distrust of statistics, enthusiasm for "prevention," protection from "bad luck," faith in science, and valuing PSA as knowledge for its own sake. Although some beliefs could be interpreted as judgment errors, most were credible on a personal level. CONCLUSIONS: Most men who underwent PSA counseling cited underlying beliefs rather than the content of counseled information as the basis for their decisions regarding future PSA screening. If widespread, such beliefs may render clinician counseling and decision support methods less effective. Eliciting patient beliefs prior to counseling may improve the shared decision-making process.