PREDICTORS OF INTEREST IN PROSTATE-SPECIFIC ANTIGEN SCREENING AND THEIMPACT OF INFORMED CONSENT - WHAT SHOULD WE TELL OUR PATIENTS

PURPOSE: Screening for prostate cancer with the prostate-specific anti gen (PSA) remains highly controversial. We sought to discern which pat ient factors predict interest in the PSA and how informed consent impa cts these predictors. PATIENTS AND METHODS: In a randomized trial that found that informed consent decreases patient interest in PSA screeni ng, potential predictors of interest were analyzed separately in the u ninformed (n = 102) and informed (n = 103) cohorts to examine the effe cts of the informational intervention. RESULTS: Univariate predictors of PSA screening interest (P < 0.05) among uninformed patients include d perceived efficacy of screening, perceived seriousness of an abnorma l PSA, and willingness to accept treatment risks. Among patients who h ad been informed about PSA screening, univariate predictors included f amily history of prostate cancer, perceived susceptibility to prostate cancer, age (inverse association), and perceived efficacy, although i nformed patients rated PSA efficacy significantly lower than uninforme d patients (P < 0.001). In multivariate logistic regression modeling f or the uninformed cohort, perceived screening efficacy (P < 0.001), pe rceived seriousness (P < 0.05), and willingness to accept treatment ri sks (P < 0.05) together were significant predictors of PSA screening i nterest. Among informed patients, perceived efficacy (P < 0.001), perc eived susceptibility (P = 0.01), and younger age (P = 0.01) together p redicted interest in screening. CONCLUSIONS: In contrast to uninformed patients, patients given information about PSA screening and prostate cancer are more likely to be interested in screening if they have a f amily history of prostate cancer, are younger, or otherwise consider t hemselves susceptible to developing prostate cancer. Uninformed patien ts are more likely to base their screening interest on the perceived s eriousness of prostate cancer and on their willingness to accept treat ment risks. (C) 1997 by Excerpta Medica, Inc.