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Primary goals, information-giving and men’s understanding: a qualitative study of Australian and UK doctors’ varied communication about PSA screening
  1. Kristen Pickles1,
  2. Stacy M Carter1,
  3. Lucie Rychetnik2,
  4. Kirsten McCaffery3,
  5. Vikki A Entwistle4
  1. 1 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
  3. 3 School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  4. 4 Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
  1. Correspondence to Kristen Pickles; kristen.pickles{at}sydney.edu.au

Abstract

Objectives (1) To characterise variation in general practitioners’ (GPs’) accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs’ reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary.

Study design and setting A grounded theory study. We interviewed 69 GPs consulting in primary care practices in Australia (n=40) and the UK (n=29).

Results GPs explained their communication practices in relation to their primary goals. In Australia, three different communication goals were reported: to encourage asymptomatic men to either have a PSA test, or not test, or alternatively, to support men to make their own decision. As well as having different primary goals, GPs aimed to provide different information (from comprehensive to strongly filtered) and to support men to develop different kinds of understanding, from population-level to ‘gist’ understanding. Taking into account these three dimensions (goals, information, understanding) and building on Entwistle et al’s Consider an Offer framework, we derived four overarching approaches to communication: Be screened, Do not be screened, Analyse and choose, and As you wish. We also describe ways in which situational and relational factors influenced GPs’ preferred communication approach.

Conclusion GPs’ reported approach to communicating about prostate cancer screening varies according to three dimensions—their primary goal, information provision preference and understanding sought—and in response to specific practice situations. If GP communication about PSA screening is to become more standardised in Australia, it is likely that each of these dimensions will require attention in policy and practice support interventions.

  • primary care
  • public health
  • qualitative research
  • prostate disease
  • organisation of health services

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Footnotes

  • Contributors KP, SC and LR conceived the study and were involved in designing the study and developing the methods. SC and LR obtained funding and were CIs on the NHMRC-funded project grant; VE was an AI on the project. 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 work was supported by Australia’s National Health and Medical Research Council (NHMRC) grant 1023197. SC reports grants from National Health and Medical Research Council Grant 1023197, 1032963; LR reports grant from National Health and Medical Research Council Grant 1023197 during the conduct of the study.

  • 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 None declared.

  • Patient consent Obtained.

  • Ethics approval All study procedures were approved by the Cancer Institute NSW and the University of Sydney Human Research Ethics Committee (#15245).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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