PREFERENCES OF ELDERLY MEN FOR PROSTATE-SPECIFIC ANTIGEN SCREENING AND THE IMPACT OF INFORMED CONSENT

Background. Use of the prostate-specific antigen (PSA) as a screening test remains highly controversial, particularly in older men. This stu dy was undertaken to assess the impact of information on the preferenc es of older men for such screening. Methods. The elderly cohort (age g reater than or equal to 65 years) of a larger randomized trial was stu died to determine the effect of a 3-minute scripted informational inte rvention on primary care patients' interest in PSA screening and on po tential predictors of screening interest. Results. Informed patients w ere significantly less interested in screening than were uninformed pa tients (p = .006). Informed patients considered PSA screening to be si gnificantly less efficacious than did uninformed patients (p = .004), but among both uninformed and informed patients, perceived efficacy co rrelated with interest in screening (multivariate OR 2.3, 95% CI 1.5-3 .8 for uninformed patients; OR 2.2, 95% CI 1.3-3.9 for informed patien ts). Perceived seriousness of prostate cancer predicted interest in sc reening among uninformed patients (OR 1.8, 95% CI 1.3-2.6), but nor am ong informed patients. Informed patients who were married were less in terested in screening than those who were single, divorced, or widowed (OR 0.3, 95% CI .08-0.9). Marital status did not predict screening in terest among uninformed patients. Conclusions. Involving elderly patie nts in the decision whether to screen with the PSA by providing them w ith information leads to a significant reduction in interest in such s creening. Factors that appear to influence the screening preferences o f informed elderly patients include perceived efficacy of screening an d marital status, whereas uninformed patients are more likely to weigh the perceived seriousness of prostate cancer in their screening decis ion.