Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK

A qualitative study

Kristen Pickles, Stacy M Carter, Lucie Rychetnik, Vikki A Entwistle

Research output: Contribution to journalArticle

7 Citations (Scopus)
3 Downloads (Pure)

Abstract

Objectives To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.

Design A grounded theory study.

Setting Primary care practices in Australia and the UK.

Participants 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.

Results GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening.

Conclusions The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed.
Original languageEnglish
Article numbere011932
JournalBMJ Open
Volume6
Issue number12
DOIs
Publication statusPublished - 5 Dec 2016

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Prostate-Specific Antigen
Early Detection of Cancer
General Practitioners
Prostatic Neoplasms
Prostate
Organizational Policy
Primary Health Care
History
Guidelines
Delivery of Health Care

Keywords

  • prostate disease
  • urology
  • prostate cancer screening
  • mindlines
  • prostate-specific antigen test
  • Australia
  • United Kingdom
  • general practitioners
  • general practice
  • primary care
  • health policy
  • qualitative methods

Cite this

Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK : A qualitative study. / Pickles, Kristen; Carter, Stacy M; Rychetnik, Lucie; Entwistle, Vikki A.

In: BMJ Open, Vol. 6, No. 12, e011932, 05.12.2016.

Research output: Contribution to journalArticle

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abstract = "Objectives To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.Design A grounded theory study.Setting Primary care practices in Australia and the UK.Participants 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.Results GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening.Conclusions The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed.",
keywords = "prostate disease, urology, prostate cancer screening, mindlines, prostate-specific antigen test, Australia, United Kingdom, general practitioners, general practice, primary care , health policy, qualitative methods",
author = "Kristen Pickles and Carter, {Stacy M} and Lucie Rychetnik and Entwistle, {Vikki A}",
note = "The project was funded by NHMRC grant number 1023197. SC was supported by NHMRC Career Development Fellowship number 1032963 when this work was completed.",
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AU - Entwistle, Vikki A

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N2 - Objectives To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.Design A grounded theory study.Setting Primary care practices in Australia and the UK.Participants 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.Results GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening.Conclusions The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed.

AB - Objectives To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different.Design A grounded theory study.Setting Primary care practices in Australia and the UK.Participants 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included.Results GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening.Conclusions The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed.

KW - prostate disease

KW - urology

KW - prostate cancer screening

KW - mindlines

KW - prostate-specific antigen test

KW - Australia

KW - United Kingdom

KW - general practitioners

KW - general practice

KW - primary care

KW - health policy

KW - qualitative methods

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SN - 2044-6055

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