Unlocking the Power of Conversation

If getting tested for cancer is available, why doesn’t everyone get tested? How can the way you communicate with your doctor impact your decision to get tested for cancer? The simple exchange of words between a personal doctor and a patient can affect the decisions to get screened for cancer. This is specifically seen with prostate cancer.

  Cancer is a disease where cells uncontrollably grow and can spread nearly everywhere in the body. Cancer cells can destroy healthy cells and damage organs. Cancer screening is a set of tests that is used to check for cancer. There are different tests used depending on what cancer your doctor is looking for and can be completed through blood samples, swabs, or physical exams where a doctor examines different parts of the body. For example, a breast physical exam would involve the doctor checking for any lumps or irregularities in the breast or a skin exam would involve the doctor checking for any changes in color and/or growths on the skin.

A prostate is a gland, the size of a walnut, that is a part of the male reproductive system and can increase in size as the male gets older. Prostate cancer is the uncontrollable growth of cells in the prostate and is the main cause of cancer in males. Both normal and cancer cells of the prostate produce a protein called a prostate-specific antigen (PSA). The amount of PSA, which can be measured through blood tests, is associated with prostate cancer making it an important measurement for detecting cancer. For patients who do not have any symptoms, PSA screening remains the most common method for early detection of prostate cancer.

Previous research has found mixed results when it comes to the benefits of early PSA screening. One study, by the European Random Study of Screening for Prostate Cancer found that there was a 20% decrease in death rate when early PSA screening was conducted. Another study, the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, found that there were no significant differences in mortality between those who were screened and those who were not. These conflicting results indicate that more research needs to be done.

The main concern regarding PSA screening is that it can lead to false positive results. False positives occur when test results say a person has a specific disease when they actually do not. This can cause some patients to go through additional testing that can harm a patient financially, physically, and emotionally. We are working to limit these types of results by increasing the research around PSA screening. 

Due to the uncertainties surrounding PSA testing, several health organizations such as the United States Preventive Services Task Force (USPSTF), the American Urological Association, and the American College of Physicians have updated their guidelines on PSA testing to encourage shared decision making between the patient and their doctor. There has also been some current research on how having the same doctor for a long time can impact a patient’s choice in getting their PSA levels checked. We wanted to see how the details of the content (what is discussed) and the context (discussions with a personal doctor) of communication can influence a patient’s decision to undergo PSA testing. We specifically analyzed data from Florida since this patient population has not been thoroughly looked at. 

We retrieved data from the 2016 Florida Behavioral Risk Factor Surveillance System. This survey is the nation’s largest telephone surveillance system that collects health-related data from individuals 18 years of age and older.

Below are some of the questions from the survey:

• Have you ever had a PSA test?

• A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer. Has a doctor, nurse, or other health professional ever talked with you about the advantages of the PSA test?

• Has a doctor, nurse, or other health professional ever talked with you about the disadvantages of the PSA test?

• Do you have one person you think of as your personal doctor or health care provider?

It is important to note that individuals who have been diagnosed with prostate cancer were not included in the study. According to the USPSTF guidelines, patients who have already been diagnosed with prostate cancer get regular and repeated PSA screening. Therefore, we did not include these patients since their decision to get PSA screened was already structured into their plan of care. 

From our study, we found that men whose personal doctors recommended testing were more likely to receive PSA testing compared with men who did not discuss testing with their doctors. When it came down to the content of discussion, men who only discussed the advantages of testing were more likely to undergo PSA testing compared to those who had no discussions at all. We also found that men who had a personal doctor were 88% more likely to get PSA testing as compared to those men who did not have one. 

These results showed that a recommendation from a health provider was the most important influence over a patient’s decision to undergo PSA testing. Historically, men who are more health-conscious or have a stronger support system are more likely to adhere to medical advice. However, we found that factors that contribute to this such as marital status, education level, alcohol use, and physical activity were not significant predictors in PSA screening in men.

  The purpose of this study was to examine the interaction between patients and their providers and the extent to which the simple exchange of words can increase a patient’s decision to undergo PSA screening. Our study displayed that the most important factors in predicting whether a patient gets testing or not is dependent on their personal doctor recommendation and discussions that include the advantages of PSA screening. The result of this study should encourage patients to communicate with their doctors about what they want or do not want regarding their own health and plan of care. 

Written by: Manasicha Wongpaiboon

Academic Editor: Physicist

Non-Academic Editor: Elementary School Teacher

Original Paper

• Title: Associations of Content and Context of Communication with Prostate-Specific Antigen Testing

• Journal: International Journal of Environmental Research and Public Health

• Date Published: 4 May 2023

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