Chan E C, Sulmasy D P
Division of General Internal Medicine, University of Texas Health Sciences Center, Houston, USA.
Am J Med. 1998 Oct;105(4):266-74. doi: 10.1016/s0002-9343(98)00257-5.
Since prostate-specific antigen (PSA) screening is controversial, some authorities recommend that patients give informed consent before testing. We identified and compared what facts experts and patients thought men should know.
We recruited a Delphi panel of national experts (6 urologists and 6 non-urologists) and conducted 6 focus groups of couples (48 subjects) with 24 screened and unscreened men from a university hospital. We ranked key facts that experts and couples thought men ought to know before consenting to PSA screening and conducted a multidisciplinary focus group to help interpret the findings.
All participants would disclose that false positive and false negative results can occur and that it is not known whether PSA screening reduces prostate cancer mortality. The 12 experts would disclose the uncertain benefits of treating early, localized prostate cancer. All 24 couples would disclose that the PSA test is a blood test and that patients may worry about results. The 6 urologists would disclose that prostate cancer is often incurable when symptoms appear; the 6 non-urologists, that it can be asymptomatic. The 12 couples with screened men would disclose that the PSA test can detect cancer sooner than the digital rectal examination; the 12 couples with unscreened men, that PSA testing is controversial.
Physicians and patients agree upon some facts that men should know about PSA screening before giving informed consent. However, physicians fail to emphasize other facts that patients find important. Physicians may differ by expertise; patients, by experience. Our findings provide content for informed consent for PSA screening, and our method may be useful for other controversial tests.
由于前列腺特异性抗原（PSA）筛查存在争议，一些权威机构建议患者在检测前给予知情同意。我们确定并比较了专家和患者认为男性应该了解的事实。
我们招募了一个由全国专家组成的德尔菲小组（6名泌尿科医生和6名非泌尿科医生），并对来自一所大学医院的24名接受过筛查和未接受过筛查的男性及其配偶进行了6个焦点小组访谈（共48名受试者）。我们对专家和夫妻认为男性在同意进行PSA筛查之前应该了解的关键事实进行了排序，并开展了一个多学科焦点小组来帮助解读研究结果。
所有参与者都会告知男性可能出现假阳性和假阴性结果，且尚不清楚PSA筛查是否能降低前列腺癌死亡率。12名专家会告知早期局限性前列腺癌治疗益处的不确定性。所有24对夫妻都会告知PSA检测是一项血液检测，患者可能会担心检测结果。6名泌尿科医生会告知前列腺癌在出现症状时往往无法治愈；6名非泌尿科医生则会告知前列腺癌可能无症状。12对有接受过筛查男性的夫妻会告知PSA检测比直肠指检能更早发现癌症；12对有未接受过筛查男性的夫妻会告知PSA检测存在争议。
医生和患者就男性在给予知情同意前应该了解的一些PSA筛查事实达成了一致。然而，医生没有强调患者认为重要的其他事实。医生可能因专业知识不同而有差异；患者则因经验不同而有差异。我们的研究结果为PSA筛查的知情同意提供了内容，我们的方法可能对其他有争议的检测有用。
