Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
Department of Health Research Methods, McMaster University, Hamilton, Burlington, Canada.
BMJ Open. 2018 Sep 5;8(9):e025470. doi: 10.1136/bmjopen-2018-025470.
To investigate men's values and preferences regarding prostate-specific antigen (PSA)-based screening for prostate cancer.
Systematic review.
We searched MEDLINE, EMBASE, PsycINFO and grey literature up to 2 September 2017.
Primary studies of men's values and preferences regarding the benefits and harms of PSA screening.
Two independent reviewers extracted data and assessed risk of bias with a modified version of a risk of bias tool for values and preferences studies, the International Patient Decision Aid Standards instrument V.3 and the Cochrane Collaboration risk of bias tool.
We identified 4172 unique citations, of which 11 studies proved eligible. Five studies investigated PSA screening using a direct choice study design, whereas six used decisions aids displaying patient-important outcomes. The direct choice studies used different methodologies and varied considerably in the reporting of outcomes. Two studies suggested that men were willing to forego screening with a small benefit in prostate cancer mortality if it would decrease the likelihood of unnecessary treatment or biopsies. In contrast, one study reported that men were willing to accept a substantial overdiagnosis to reduce their risk of prostate cancer mortality. Among the six studies involving decision aids, willingness to undergo screening varied substantially from 37% when displaying a hypothetical reduction in mortality of 10 per 1000 men, to 44% when displaying a reduction in mortality of 7 per 1000. We found no studies that specifically investigated whether values and preferences differed among men with family history, of African descent or with lower socioeconomic levels.
The variability of men's values and preferences reflect that the decision to screen is highly preference sensitive. Our review highlights the need for shared decision making in men considering prostate cancer screening.
CRD42018095585.
调查男性对前列腺特异性抗原（PSA）前列腺癌筛查的价值观和偏好。
系统评价。
我们检索了 MEDLINE、EMBASE、PsycINFO 和灰色文献，检索时间截至 2017 年 9 月 2 日。
关于 PSA 筛查的获益和危害的男性价值观和偏好的原始研究。
两名独立评审员使用改良的价值观和偏好研究风险工具、国际患者决策辅助标准工具 V.3 和 Cochrane 协作组风险偏倚工具，提取数据并评估风险偏倚。
我们共识别出 4172 个独特的引用，其中 11 项研究符合纳入标准。五项研究使用直接选择研究设计调查 PSA 筛查，而六项研究使用显示患者重要结局的决策辅助工具。直接选择研究使用了不同的方法学，在结局报告方面差异很大。两项研究表明，如果 PSA 筛查能够降低不必要的治疗或活检的可能性，男性愿意放弃筛查，以换取前列腺癌死亡率的微小降低。相比之下，一项研究报告称，男性愿意接受大量过度诊断，以降低前列腺癌死亡率。在涉及决策辅助的六项研究中，愿意接受筛查的比例从显示每 1000 名男性死亡人数减少 10 人时的 37%，到显示死亡人数减少 7 人时的 44%，差异很大。我们没有发现专门研究有家族史、非裔或社会经济地位较低的男性的价值观和偏好是否存在差异的研究。
男性价值观和偏好的可变性反映出筛查决策高度依赖于个人偏好。我们的综述强调了在考虑前列腺癌筛查时需要进行共同决策。
CRD42018095585。
