ProsDex Development
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ProsDex Development

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Development of PresDex online decision support intervention for men facing the PSA test.

Development of PresDex online decision support intervention for men facing the PSA test.

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Transcript

  • 1. ‘ It’s a maybe test’: narratives from primary care about the PSA test
    • Dr Rhodri Evans
    • Prof Adrian Edwards
    • Prof Glyn Elwyn
  • 2. Background
    • UK Prostate Cancer Risk Management Programme
    • Prosdex : web-based, PSA decision explorer
    • Experiences of men who have undergone PSA testing
    • Reality of PSA testing in UK primary care
    • Qualitative study
  • 3. Methods
    • Men between 40 and 75
    • Wales, UK: range of settings
    • Identified by General Practitioners + Urologist
    • Semi-structured interviews
  • 4. Results
    • 28/32: interviews transcribed
    • 25/28: recruited from primary care
    • 27/28: PSA test
    • 11/28: ‘normal’ PSA test
    • 6/28: prostate cancer
  • 5. Analysis of themes
    • 1: Uncertainties of the PSA testing process
    • 2: Men’s varied understanding
    • 3: Decision making context
    • 4: Locus of decision making
    • 5: Men’s desires for tests
  • 6. 1: Uncertainties of PSA testing
    • It a ‘maybe’ test. Maybe you have, maybe you haven’t.
    • Although the test would find out whether I had prostate cancer, it wasn’t the be all and end all. In other words, if I came up as clear, there still may be some signs there, which I thought was a little strange at the time.
  • 7. 2: Men’s varied understanding
    • I really didn’t think it was all about having prostate cancer. I hadn’t realised that at all, I have to say.
    • You’ve got the pussy cat type where it’s better left alone, and the tiger type then of course, needing strong action immediately, or at least an eye kept on it
  • 8. 3. Decision making context
    • 1. Social context
    • 2. Physical symptoms
    • 3. Media influences
    • 4. Information from doctors
    • 5. Different desires for information
    • 6. Certainty of outcomes
  • 9. 4. Locus of decision making
    • Mostly doctor-centred:
    • I know my doctor very well. He’s been treating me now since I left the army. He suggested a blood test, and I said fine. He didn’t have to go into the details.
    • Rarely patient-centred:
    • I went and asked for it. Because a friend of mine had died, through prostate cancer, and I being roughly the same age, I thought I would go and have a check up myself.
  • 10. 5. Men’s desires for tests
    • I think it’s a jolly good idea, because men can get cancer of the prostate and it’s just as well to have the test. Women get their breasts tested, so men should have tests on their prostate.
    • Taking your blood pressure, blood sugar level; it just seemed like another one of those tests at the time.
  • 11. Conclusions
    • 1. Uncertainty throughout the PSA testing process
    • 2. Men’s understanding varies considerably
    • 3. A range of factors influence the decision
    • 4. A doctor-centred decision making process
    • 5. Men enthusiastic about the test
    • 6. Little known about men who decline the test
  • 12.