Gerard M J, Frank-Stromborg M
College of Law, Northern Illinois University, DeKalb, USA.
Oncol Nurs Forum. 1998 Oct;25(9):1561-9.
PURPOSE/OBJECTIVES: To describe the opposing recommendations of the major medical organizations related to screening for prostate cancer and to explore the impact of these opposing recommendations on advanced practice nurses (APNs) who are in a position to decide who gets screened and when.
Published medical, legal, and economic articles, published legal verdicts and settlements, case law, and news reports.
The national recommendations for screening for prostate cancer are conflicting and have legal, economic, and ethical implications for healthcare practitioners. Both the current early diagnostic tests, age- and race-based prostate specific antigen ranges, and the resultant treatment have significant problems and further contribute to the national controversy about whether to screen asymptomatic men. Lack of coverage for early detection of prostate cancer by many managed-care plans and Medicare also contribute to the dilemma practitioners face. However, electing not to screen "at-risk" men may subject APNs to charges of negligence or other legal theories.
Present recommendations by the leading national medical, cancer, and policy organizations related to prostate cancer screening are contradictory. Adding to this national quagmire is the lack of financial support from Medicare and most health maintenance organization plans to pay for early detection of prostate cancer. These conflicting recommendations place APNs in a legally and ethically precarious position. APNs and nurses with patient education responsibilities should individualize decision-making and counsel their asymptomatic patients who may be at risk for prostate cancer about the benefits and complications of screening.
Considering the multiple implications of the decision to screen for prostate cancer, counseling patients who may be at risk for the disease and involving them and their spouses may be the best approach in deciding whether to screen for prostate cancer in asymptomatic men.
目的/目标：描述主要医学组织关于前列腺癌筛查的相反建议，并探讨这些相反建议对有能力决定谁接受筛查以及何时接受筛查的高级执业护士（APN）的影响。
已发表的医学、法律和经济文章、已发表的法律裁决和和解协议、判例法及新闻报道。
国家关于前列腺癌筛查的建议相互冲突，对医疗从业者具有法律、经济和伦理意义。当前的早期诊断测试、基于年龄和种族的前列腺特异性抗原范围以及由此产生的治疗方法都存在重大问题，进一步加剧了关于是否对无症状男性进行筛查的全国性争议。许多管理式医疗计划和医疗保险对前列腺癌早期检测的覆盖不足也加剧了从业者面临的困境。然而，选择不对“高危”男性进行筛查可能会使高级执业护士面临疏忽指控或其他法律理论。
主要国家医学、癌症和政策组织目前关于前列腺癌筛查的建议相互矛盾。医疗保险和大多数健康维护组织计划缺乏对前列腺癌早期检测的资金支持，这使这个全国性的困境更加复杂。这些相互冲突的建议使高级执业护士处于法律和伦理上的不稳定地位。高级执业护士和负责患者教育的护士应个体化决策，并就筛查的益处和并发症向可能有前列腺癌风险的无症状患者提供咨询。
考虑到前列腺癌筛查决策的多重影响，为可能患有该疾病的患者提供咨询，并让他们及其配偶参与，可能是决定是否对无症状男性进行前列腺癌筛查的最佳方法。
