Men’s perspectives of prostate cancer screening: A systematic review of qualitative studies

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Abstract

Background

Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for prostate cancer is widely accepted; however concerns regarding the harms outweighing the benefits of screening exist. Although patient’s play a pivotal role in the decision making process, men may not be aware of the controversies regarding prostate cancer screening. Therefore we aimed to describe men’s attitudes, beliefs and experiences of prostate cancer screening.

Methods

Systematic review and thematic synthesis of qualitative studies on men’s perspectives of prostate cancer screening. Electronic databases and reference lists were searched to October 2016.

Findings

Sixty studies involving 3,029 men aged from 18–89 years, who had been screened for prostate cancer by Prostate Specific Antigen (PSA) or Digital Rectal Examination (DRE) and not screened, across eight countries were included. Five themes were identified: Social prompting (trusting professional opinion, motivation from family and friends, proximity and prominence of cancer); gaining decisional confidence (overcoming fears, survival imperative, peace of mind, mental preparation, prioritising wellbeing); preserving masculinity (bodily invasion, losing sexuality, threatening manhood, medical avoidance); avoiding the unknown and uncertainties (taboo of cancer-related death, lacking tangible cause, physiological and symptomatic obscurity, ambiguity of the procedure, confusing controversies); and prohibitive costs.

Conclusions

Men are willing to participate in prostate cancer screening to prevent cancer and gain reassurance about their health, particularly when supported or prompted by their social networks or healthcare providers. However, to do so they needed to mentally overcome fears of losing their masculinity and accept the intrusiveness of screening, the ambiguities about the necessity and the potential for substantial costs. Addressing the concerns and priorities of men may facilitate informed decisions about prostate cancer screening and improve patient satisfaction and outcomes.

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Faeco-prevalence of Campylobacter jejuni in urban wild birds and pets in New Zealand

Vathsala Mohan (2015)

Background Greater attention has been given to Campylobacter jejuni (C. jejuni) prevalence in poultry and ruminants as they are regarded as the major contributing reservoirs of human campylobacteriosis. However, relatively little work has been done to assess the prevalence in urban wild birds and pets in New Zealand, a country with the highest campylobacteriosis notification rates. Therefore, the aim of the study was to assess the faeco-prevalence of C. jejuni in urban wild birds and pets and its temporal trend in the Manawatu region of New Zealand. Findings A repeated cross-sectional study was conducted from April 2008 to July 2009, where faecal samples were collected from 906 ducks, 835 starlings, 23 Canadian goose, 2 swans, 2 pied stilts, 498 dogs and 82 cats. The faeco-prevalence of C. jejuni was 20% in ducks, 18% in starlings, 9% in Canadian goose, 5% in dogs and 7% in cats. The faeco-prevalence of C. jejuni was relatively higher during warmer months of the year in ducks, starlings and dogs while starlings showed increased winter prevalence. No such trend could be assessed in Canadian goose, swans, pied stilts and cats as samples could not be collected for the entire study period from these species. Conclusions This study estimated the faeco-prevalence of C. jejuni in different animal species where the prevalence was relatively high during warmer months in general. However, there was relative increase in winter prevalence in starlings. The urban wild bird species and pets may be considered potential risk factors for human campylobacteriosis in New Zealand, particularly in small children.

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Decision aids for people facing health treatment or screening decisions.

Dawn Stacey, Tom Barry, N Col … (2010)

Decision aids prepare people to participate in decisions that involve weighing benefits, harms, and scientific uncertainty. To evaluate the effectiveness of decision aids for people facing treatment or screening decisions. For this update, we searched from January 2006 to December 2009 in MEDLINE (Ovid); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 4 2009); CINAHL (Ovid) (to September 2008 only); EMBASE (Ovid); PsycINFO (Ovid); and grey literature. Cumulatively, we have searched each database since its start date. We included published randomised controlled trials (RCTs) of decision aids, which are interventions designed to support patients' decision making by providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies in which participants were not making an active treatment or screening decision. Two review authors independently screened abstracts for inclusion, extracted data, and assessed potential risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards, were:A) decision attributes;B) decision making process attributes.Secondary outcomes were behavioral, health, and health system effects. We pooled results of RCTs using mean differences (MD) and relative risks (RR), applying a random effects model. Of 34,316 unique citations, 86 studies involving 20,209 participants met the eligibility criteria and were included. Thirty-one of these studies are new in this update. Twenty-nine trials are ongoing. There was variability in potential risk of bias across studies. The two criteria that were most problematic were lack of blinding and the potential for selective outcome reporting, given that most of the earlier trials were not registered.Of 86 included studies, 63 (73%) used at least one measure that mapped onto an IPDAS effectiveness criterion: A) criteria involving decision attributes: knowledge scores (51 studies); accurate risk perceptions (16 studies); and informed value-based choice (12 studies); and B) criteria involving decision process attributes: feeling informed (30 studies) and feeling clear about values (18 studies).A) Criteria involving decision attributes:Decision aids performed better than usual care interventions by increasing knowledge (MD 13.77 out of 100; 95% confidence interval (CI) 11.40 to 16.15; n = 26). When more detailed decision aids were compared to simpler decision aids, the relative improvement in knowledge was significant (MD 4.97 out of 100; 95% CI 3.22 to 6.72; n = 15). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.74; 95% CI 1.46 to 2.08; n = 14). The effect was stronger when probabilities were expressed in numbers (RR 1.93; 95% CI 1.58 to 2.37; n = 11) rather than words (RR 1.27; 95% CI 1.09 to 1.48; n = 3). Exposure to a decision aid with explicit values clarification compared to those without explicit values clarification resulted in a higher proportion of patients achieving decisions that were informed and consistent with their values (RR 1.25; 95% CI 1.03 to 1.52; n = 8).B) Criteria involving decision process attributes:Decision aids compared to usual care interventions resulted in: a) lower decisional conflict related to feeling uninformed (MD -6.43 of 100; 95% CI -9.16 to -3.70; n = 17); b) lower decisional conflict related to feeling unclear about personal values (MD -4.81; 95% CI -7.23 to -2.40; n = 14); c) reduced the proportions of people who were passive in decision making (RR 0.61; 95% CI 0.49 to 0.77; n = 11); and d) reduced proportions of people who remained undecided post-intervention (RR 0.57; 95% CI 0.44 to 0.74; n = 9). Decision aids appear to have a positive effect on patient-practitioner communication in the four studies that measured this outcome. For satisfaction with the decision (n = 12) and/or the decision making process (n = 12), those exposed to a decision aid were either more satisfied or there was no difference between the decision aid versus comparison interventions. There were no studies evaluating the decision process attributes relating to helping patients to recognize that a decision needs to be made or understand that values affect the choice.C) Secondary outcomesExposure to decision aids compared to usual care continued to demonstrate reduced choice of: major elective invasive surgery in favour of conservative options (RR 0.80; 95% CI 0.64 to 1.00; n = 11). Exposure to decision aids compared to usual care also resulted in reduced choice of PSA screening (RR 0.85; 95% CI 0.74 to 0.98; n = 7). When detailed compared to simple decision aids were used, there was reduced choice of menopausal hormones (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable. The effect of decision aids on length of consultation varied from -8 minutes to +23 minutes (median 2.5 minutes). Decision aids do not appear to be different from comparisons in terms of anxiety (n = 20), and general health outcomes (n = 7), and condition specific health outcomes (n = 9). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. New for this updated review is evidence that: decision aids with explicit values clarification exercises improve informed values-based choices; decision aids appear to have a positive effect on patient-practitioner communication; and decision aids have a variable effect on length of consultation.Consistent with findings from the previous review, which had included studies up to 2006: decision aids increase people's involvement, and improve knowledge and realistic perception of outcomes; however, the size of the effect varies across studies. Decision aids have a variable effect on choices. They reduce the choice of discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, patient-practitioner communication, cost-effectiveness, and use with developing and/or lower literacy populations need further evaluation. Little is known about the degree of detail that decision aids need in order to have positive effects on attributes of the decision or decision-making process.

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Recommendations on screening for prostate cancer with the prostate-specific antigen test.

N. Bell, S. C. Gorber, A Shane … (2014)

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Author and article information

Contributors

Laura J. James:

ORCID: http://orcid.org/0000-0002-0635-8420

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: Writing – original draftRole: Writing – review & editing

Germaine Wong: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing

Jonathan C. Craig: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing

Camilla S. Hanson: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: Writing – review & editing

Angela Ju: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: Writing – review & editing

Kirsten Howard: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing

Tim Usherwood: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing

Howard Lau: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing

Allison Tong: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – review & editing

Jo Waller: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 28 November 2017

Publication date Collection: 2017

Volume: 12

Issue: 11

Electronic Location Identifier: e0188258

Affiliations

[1 ] Sydney School of Public Health, The University of Sydney, Sydney, Australia

[2 ] Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia

[3 ] Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia

[4 ] Department of General Practice, Westmead Clinical School, The University of Sydney, Sydney, Australia

[5 ] The George Institute for Global Health, Sydney, Australia

[6 ] Department of Urology, Westmead Hospital, Westmead, Australia

UCL, UNITED KINGDOM

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: laura.james@ 123456health.nsw.gov.au

Author information

Laura J. James http://orcid.org/0000-0002-0635-8420

Article

Publisher ID: PONE-D-16-49383

DOI: 10.1371/journal.pone.0188258

PMC ID: 5705146

PubMed ID: 29182649

SO-VID: 55651cdf-c659-4a09-ad39-b72aac16088f

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 28 December 2016

Date accepted : 1 November 2017

Page count

Figures: 2, Tables: 3, Pages: 23

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;

Award ID: APP1092957

Award Recipient : Jonathan C. Craig

LJJ and JCC are supported by the National Health and Medical Research Council Program Grant (APP1092957). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Men’s perspectives of prostate cancer screening: A systematic review of qualitative studies

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Faeco-prevalence of Campylobacter jejuni in urban wild birds and pets in New Zealand

Decision aids for people facing health treatment or screening decisions.

Recommendations on screening for prostate cancer with the prostate-specific antigen test.

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