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Why men with prostate cancer want wider access to prostate specific antigen testing: qualitative study
Alison Chapple1, Sue Ziebland, Sasha Shepperd
1Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF. alison.chapple@dphpc.ox.ac.uk
Objectives:
To explore the attitudes of men with confirmed or suspected prostate cancer to testing for prostate specific antigen.
Design:
Qualitative interview study with a purposive sample.
Setting:
Great Britain.
Participants:
52 men with suspected or confirmed prostate cancer, recruited through general practitioners, urologists, patient support groups, and charities.
Results:
Almost all men remembered their prostate specific antigen test but recalled being given little information beforehand. Arguments in favour of increased access to testing included the belief that early diagnosis would reduce mortality, improve quality of life, and save the NHS money. Men also thought that a national screening programme should be available because symptoms can be ambiguous, screening for cancer is responsible health behaviour, and screening would encourage men to be tested. Four men who opposed a screening programme had gathered information alerting them to uncertainty about the benefits of treatment, and two regretted that they had been tested. Others thought that access to testing is restricted in the United Kingdom because of a lack of government backing, concerns about the accuracy of the test, and a lack of resources.
Conclusions:
The few men in this study who subscribed to the argument that evidence of the benefits of treatment is a prerequisite for a screening programme did not want to see screening introduced. Men who proposed an alternative set of principles for testing gave reasons that did not all relate to overoptimism about the benefits of early diagnosis. People who plan services and people who respond to requests for testing need to understand men's perspectives and concerns.