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.
- prostate cancer screening
- prostate-specific antigen test
- united kingdom
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Contributors All authors conceived the study and were involved in designing the study and developing the methods. SMC and LR obtained funding and are CIs on the NHMRC-funded project grant. KP conducted the interviews, had full access to all data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. KP drafted the manuscript. All authors contributed to the interpretation of the analysis and critically revised the manuscript.
Funding The project was funded by NHMRC grant number 1023197. SC was supported by NHMRC Career Development Fellowship number 1032963 when this work was completed.
Disclaimer The funders had no role in the design or conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation or approval of the manuscript.
Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: SC was supported by NHMRC Career Development Fellowship number 1032963 when this work was completed; they have no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; they have no other relationships or activities that could appear to have influenced the submitted work.
Ethics approval All study procedures were approved by the Cancer Institute New South Wales and the University of Sydney Human Research Ethics Committee [#15245]. Each participant had an opportunity to discuss the study, and gave written consent prior to participation.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Transparency KP affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted.
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