Internal Medicine, Pediatrics, & Population Health-Bioethics, Medical College of Wisconsin, Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA.
Patient Educ Couns. 2009 Dec;77(3):322-7. doi: 10.1016/j.pec.2009.09.023. Epub 2009 Oct 17.
To assess the content of counseling about prostate-specific antigen (PSA) screening. Guidelines recommend informed consent before screening because of concerns about benefits versus risks. As part of the professional practice standard for informed consent, clinicians should include content customarily provided by experts.
40 transcripts of conversations between medicine residents and standardized patients were abstracted using an instrument derived from an expert Delphi panel that ranked 10 "facts that experts believe men ought to know."
Transcripts contained definite criteria for an average of 1.7 facts, and either definite or partial criteria for 5.1 facts. Second- and third-year residents presented more facts than interns (p=0.01). The most common facts were "false positive PSA tests can occur" and "use of the PSA test as a screening test is controversial." There was an r=0.88 correlation between inclusion by residents and the experts' ranking.
Counseling varied but most transcripts included some expert-recommended facts. The absence of other facts could be a quality deficit or an effort to prioritize messages and lessen cognitive demands on the patient.
Clinicians should adapt counseling for each patient, but our abstraction approach may help to assess the quality of informed consent over larger populations.
评估前列腺特异性抗原（PSA）筛查咨询的内容。指南建议在筛查前进行知情同意，因为需要权衡其获益和风险。作为知情同意专业实践标准的一部分，临床医生应该包括专家通常提供的内容。
从专家德尔菲小组排名的 10 个“专家认为男性应该知道的事实”中得出的工具，对 40 名医学住院医师与标准化患者之间对话的记录进行了摘要。
记录中包含了平均 1.7 个事实的明确标准，以及 5.1 个事实的明确或部分标准。第二年和第三年住院医师比实习医生提供的事实更多（p=0.01）。最常见的事实是“PSA 检测可能出现假阳性”和“使用 PSA 检测作为筛查试验存在争议”。住院医师纳入的事实与专家排名之间存在 r=0.88 的相关性。
咨询内容各不相同，但大多数记录都包含了一些专家推荐的事实。缺乏其他事实可能是质量缺陷，也可能是为了优先考虑信息，并减轻患者的认知负担。
临床医生应该为每位患者调整咨询内容，但我们的抽象方法可能有助于评估更大人群知情同意的质量。
