Patient perceptions of how physicians communicate during prostate cancer screening discussions: a comparison of...

Residents are required to demonstrate competency in communication skills. Prostate cancer screening discussions are examples of complex physician-patient communication processes, requiring an objective presentation of the known risks, potential benefits, and scientific uncertainties surrounding screening. National organizations recommend shared decision making (SDM) in these discussions.

A stratified analysis to contrast resident and faculty outcomes was planned as part of a randomized controlled trial comparing decision aids for prostate cancer screening in a suburban Washington, DC, residency practice. All eligible men between the ages of 50 and 70 years scheduled for a wellness examination with either a resident or a faculty physician were randomly assigned to one of two intervention arms (Web- or paper-based decision aid) or to the control group (no pre-visit education). Patients were asked to complete exit surveys that evaluated their perceptions of key elements of SDM for prostate cancer screening (PCS).

Patients seen by resident physicians were younger than patients seen by faculty, and a smaller proportion had undergone previous prostate-specific antigen (PSA) testing. Patients seen by residents and faculty reported similar levels of the elements of SDM (eg, knowledge about PCS, achieving their desired locus of control for the decision) and similar time spent discussing screening. Both groups also had nearly identical decisional conflict scores and PSA testing rates. Residents discussed more PCS topics (6.3 versus 5.3 topics), including more topics that might influence a patient to decide against screening, than did faculty physicians.

According to patient perceptions, residents appeared to perform as well as faculty in SDM and other aspects of PCS discussions, although the topics that they covered with patients might have differed.