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

Journal Article


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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.

UOW Authors


  •   Pickles, Kristen (external author)
  •   Carter, Stacy
  •   Rychetnik, Lucie (external author)
  •   Entwistle, Vikki A. (external author)

Publication Date


  • 2016

Citation


  • Pickles, K., Carter, S. M., Rychetnik, L. & Entwistle, V. A. (2016). Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study. BMJ Open, 6 (12), e011932-1-e011932-12.

Scopus Eid


  • 2-s2.0-85006098532

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=4767&context=sspapers

Ro Metadata Url


  • http://ro.uow.edu.au/sspapers/3758

Has Global Citation Frequency


Start Page


  • e011932-1

End Page


  • e011932-12

Volume


  • 6

Issue


  • 12

Place Of Publication


  • United Kingdom

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.

UOW Authors


  •   Pickles, Kristen (external author)
  •   Carter, Stacy
  •   Rychetnik, Lucie (external author)
  •   Entwistle, Vikki A. (external author)

Publication Date


  • 2016

Citation


  • Pickles, K., Carter, S. M., Rychetnik, L. & Entwistle, V. A. (2016). Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study. BMJ Open, 6 (12), e011932-1-e011932-12.

Scopus Eid


  • 2-s2.0-85006098532

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=4767&context=sspapers

Ro Metadata Url


  • http://ro.uow.edu.au/sspapers/3758

Has Global Citation Frequency


Start Page


  • e011932-1

End Page


  • e011932-12

Volume


  • 6

Issue


  • 12

Place Of Publication


  • United Kingdom