Invited Commentary |

Improving the Quality of Decision-Making Processes for Prostate Cancer Screening:  Progress and Challenges

Daniel S. Reuland, MD, MPH1,2,3; Michael Pignone, MD, MPH1,2,3
[+] Author Affiliations
1Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina, Chapel Hill
2Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
JAMA Intern Med. 2013;173(18):1713-1714. doi:10.1001/jamainternmed.2013.6561.
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Guidelines recommend that patients be informed about potential benefits and harms from prostate cancer screening and that screening decisions involve a discussion between patients and their physicians.1,2 Despite this consensus, achieving high-quality decision-making processes in practice is difficult. Clinicians function in a time-constrained environment and know that ordering a prostate-specific antigen (PSA) blood test is simple, whereas ensuring that patients fully understand the potential ramifications of entering a screening program is far more difficult and time-consuming. Explaining such concepts as biopsy threshold, false-positive results, overdiagnosis, and uncertainty about magnitude of benefit is challenging and cannot be done quickly.

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