Scripties UMCG - Rijksuniversiteit Groningen
 
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Screening for prostate cancer - medical policy by general practitioners in the northern part of the Netherlands

(2016) Koops, L. (Lisa)

Introduction - The prostate-specific antigen (PSA) test has been widely introduced in the nineties. The use of the test as a screening method for prostate cancer is highly debated worldwide. Advocates argue that the PSA test allows for early detection of prostate cancer and the resulting decline in mortality, while opponents state that the PSA test has more negative consequences such as overdiagnosis and overtreatment. Guidelines concerning screening differ per country, and GPs (general practitioner) within the same continent have distinctive methods of using the PSA test. The aim of this study was to characterize the medical policy of GPs in the northern part of the Netherlands regarding PSA screening for prostate cancer.
Methods - A questionnaire was developed by the German counterpart of the study. After translating the questionnaire, a pilot study was conducted to test for feasibility and validity. The renewed version was spread during a training day for GP trainees (n=23) and it was sent to 179 GPs in the catchment area of the University Medical Center Groningen (UMCG). The questionnaire was designed to determine the associations between medical policy regarding the PSA test and characteristics and attitude of the GPs and consisted of three topics. The first topic was the use of PSA testing in practice. The second topic concerned determinants of PSA testing strategies. The third topic concerned the use of guidelines in PSA testing strategies.
Results - The study had an average response rate of 36% (100%, and 27.9%, respectively; n = 73). Regarding the characteristics, GPs who worked in a duo or group practice were more likely to perform a PSA test if a patient actively requested it (p = 0.046). Working experience of ten or more years was associated with a smaller probability to recommend the PSA test to relatives (p = 0.047). Concerning the attitude, GPs that are afraid of missing prostate cancer and GPs who find screening for cancer in general unimportant are more likely to perform a PSA test when a patient asks for it (p = 0.017, and p = 0.043, respectively). The majority of the GPs discusses the benefits and disadvantages of the PSA test with patients who actively request screening for PSA screening. GPs who are not afraid of missing prostate cancer and who find screening for cancer in general unimportant are less likely to recommend the PSA test to relatives (p = 0.001, and p = 0.001, respectively).
Conclusion - Working in a duo or group practice and being afraid of missing prostate cancer are correlated with a higher probability to perform PSA testing when a patient actively asks for screening for prostate cancer. GPs with ten or more years of working experience and not being afraid of missing prostate cancer are less likely to recommend the PSA test to their relatives. Finding screening for cancer in general unimportant is associated with both being more likely to performing a PSA and not recommending the PSA test to relatives.





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