Family Practice Vol. 20, No. 3, 294-303
© Oxford University Press 2003
Screening |
GP and patient predictors of PSA screening in Australian general practice
a Division of Population Health, South Western Sydney Area Health Service,
b School of Public Health, University of Sydney, and
c Surgical Outcomes Research Centre (SOuRCe), Central Sydney Area Health Service, Sydney, Australia.
Correspondence to Professor Jeanette E Ward, Director, Division of Population Heath, South Western Sydney Area Health Service, Locked Bag 7008, Liverpool NSW 1871, Australia; Email: Jeanette.Ward{at}swsahs.nsw.gov.au
Objective. We determined GP and patient variables associated first with men’s prior uptake of prostate-specific antigen (PSA) screening and, subsequently, its initiation during an ‘index consultation’ in Australian general practice.
Methods. From the practices of 60 GPs, we recruited a sample of 423 male patients aged 40–70 years. In a waiting room questionnaire completed before their ‘index consultation’ (retrospective component), men reported their previous PSA screening status. We obtained demographic and clinical data, including the presence of lower urinary tract symptoms (LUTS). Men also were mailed a questionnaire 2 days after their ‘index consultation’ to ascertain whether the GP had discussed PSA screening (prospective component) for prostate cancer and other behaviours. GPs themselves completed questionnaires eliciting demographic and practice characteristics as well as their propensity to screen and understanding of the evidence about PSA testing. GP and patient study variables were modelled simultaneously in analyses.
Results. Of those 348 men consulting with their regular GP, 80 (23.0%) reported previously having had a PSA screening test. Men were significantly and independently more likely ever to have had PSA screening if their regular GP reported a propensity to initiate screening [adjusted odds ratio (AOR) = 2.27, 95% confidence interval (CI) 1.23–4.20; P = 0.009]. GP age also was independently associated with men’s PSA screening status [chi-squared (3) P < 0.0001] as was men’s age and severity of LUTS (AOR = 2.38, 95% CI 1.58–3.57, P < 0.0001 and AOR = 1.79, 95% CI 1.00–3.19, P = 0.004, respectively). Current smokers were less likely ever to have had a PSA screening test (AOR = 0.34, 95% CI 0.16–0.69; P = 0.003). Discussion of PSA screening in their ‘index consultation’ was recalled independently more often by older men (AOR = 1.46, 95% CI 1.00–2.13; P = 0.04), those with moderate/severe LUTS (AOR = 1.94, 1.07–3.49; P = 0.04), those whose GP had performed or discussed a cholesterol test (AOR = 2.26, 95% CI 1.03–4.92; P = 0.04) and those whose GP had postgraduate training in family medicine (AOR = 3.13, 95% CI 1.23–8.00; P = 0.02).
Conclusion. In the absence as yet of compelling evidence that PSA screening will prolong life or enhance its quality, our findings identify GP and patient factors that could be targeted to modify PSA screening.
Keywords. Evidence-based practice, general practice, PSA screening.
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