{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T21:48:57Z","timestamp":1775252937682,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,4,12]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is variability in how family physicians (FPs) approach PSA testing in asymptomatic men. The purpose of our study was to explore how family FPs approach discussions with their male patients around PSA testing in Manitoba, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative descriptive study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>High-ordering and median-ordering FPs were invited to participate in an interview. In addition to exploring practice behaviours around PSA testing, participants were asked to elaborate on their typical discussion with asymptomatic men who request a PSA test or other tests and procedures that they do not feel are clinically warranted. Data were analysed inductively using a constant-comparison approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were important variations between high-ordering and median-ordering FP\u2019s approaches to discussing PSA testing. Strategies to facilitate conversations were more frequently identified by median-ordering physicians and often included methods to facilitate assessing their patient\u2019s understanding and values. In addition to decision aids, median-ordering FPs used motivational interviewing to tailor a discussion, organised their practice structure and workflow habits in a way that enhanced patient\u2013provider discussions and leveraged \u2018new\u2019 evidence and other aids to guide conversations with men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found that high-ordering FPs tended to use the PSA test for screening asymptomatic men with limited shared decision-making. Median-ordering FPs used conversational strategies that emphasised uncertainty of benefit and potential risk and did not present the test as a recommendation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073415","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T13:31:26Z","timestamp":1682688686000},"page":"e073415","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3769-5785","authenticated-orcid":false,"given":"S Michelle","family":"Driedger","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5353-2559","authenticated-orcid":false,"given":"Sarah","family":"Kirby","sequence":"additional","affiliation":[{"name":"George & Fay Yee Centre for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4098-6751","authenticated-orcid":false,"given":"Ryan","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"S\u00fcss","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurel","family":"Thorlacius","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Department of Biochemistry and Medical Genetics, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffery W","family":"Saranchuk","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Bohm","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"key":"2025121222105141000_13.4.e073415.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k3519","article-title":"Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis","volume":"362","author":"Ilic","year":"2018","journal-title":"BMJ"},{"key":"2025121222105141000_13.4.e073415.2","article-title":"Screening for prostate cancer","volume":"2013","author":"Ilic","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121222105141000_13.4.e073415.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2007.03.135"},{"key":"2025121222105141000_13.4.e073415.4","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/95.12.868"},{"key":"2025121222105141000_13.4.e073415.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e3502","article-title":"Preventing overdiagnosis: how to stop harming the healthy","volume":"344","author":"Moynihan","year":"2012","journal-title":"BMJ"},{"key":"2025121222105141000_13.4.e073415.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1541-0420.2007.00825.x"},{"key":"2025121222105141000_13.4.e073415.7","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq099"},{"key":"2025121222105141000_13.4.e073415.8","unstructured":"Royal Australian College of General Practitioners (RACGP) . Red book - early detection of cancers. n.d. Available: https:\/\/www.racgp.org.au\/clinical-resources\/clinical-guidelines\/key-racgp-guidelines\/view-all-racgp-guidelines\/guidelines-for-preventive-activities-in-general-pr\/early-detection-of-cancers\/prostrate-cancer"},{"key":"2025121222105141000_13.4.e073415.9","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.140703"},{"key":"2025121222105141000_13.4.e073415.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.3710"},{"key":"2025121222105141000_13.4.e073415.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2013.04.119"},{"key":"2025121222105141000_13.4.e073415.12","doi-asserted-by":"crossref","first-page":"E184","DOI":"10.5489\/cuaj.7851","article-title":"Update \u2013 2022 Canadian urological association recommendations on prostate cancer screening and early diagnosis: endorsement of the 2021 cancer care Ontario guidelines on prostate multiparametric magnetic resonance imaging","volume":"16","author":"Mason","year":"2022","journal-title":"CUAJ"},{"key":"2025121222105141000_13.4.e073415.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-8-35","article-title":"The PSA testing dilemma: GPs\u2019 reports of consultations with asymptomatic men: a qualitative study","volume":"8","author":"Clements","year":"2007","journal-title":"BMC Fam Pract"},{"key":"2025121222105141000_13.4.e073415.14","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-6-24","article-title":"Psa testing for prostate cancer: an online survey of the views and reported practice of general practitioners in the UK","volume":"6","author":"Brett","year":"2005","journal-title":"BMC Fam Pract"},{"key":"2025121222105141000_13.4.e073415.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2003.09.035"},{"key":"2025121222105141000_13.4.e073415.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.04.011"},{"key":"2025121222105141000_13.4.e073415.17","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-007-0142-3"},{"key":"2025121222105141000_13.4.e073415.18","doi-asserted-by":"crossref","first-page":"396","DOI":"10.5489\/cuaj.4486","article-title":"Prostate-specific antigen testing for prostate cancer screening: a national survey of Canadian primary care physicians\u2019 opinions and practices","volume":"11","author":"Goldenberg","year":"2017","journal-title":"CUAJ"},{"key":"2025121222105141000_13.4.e073415.19","doi-asserted-by":"crossref","first-page":"E319","DOI":"10.5489\/cuaj.6072","article-title":"Prostate-specific antigen (PSA) screening rates and factors associated with screening in eastern Canadian men: findings from cross-sectional survey data","volume":"14","author":"Tchir","year":"2020","journal-title":"Can Urol Assoc J"},{"key":"2025121222105141000_13.4.e073415.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2014.08.006"},{"key":"2025121222105141000_13.4.e073415.21","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/j.1464-410X.2006.06481.x","article-title":"Prostate-specific antigen testing: uncovering primary care influences","volume":"98","author":"Gormley","year":"2006","journal-title":"BJU Int"},{"key":"2025121222105141000_13.4.e073415.22","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-10-3","article-title":"Factors prompting PSA-testing of asymptomatic men in a country with no guidelines: a national survey of general practitioners","volume":"10","author":"Drummond","year":"2009","journal-title":"BMC Fam Pract"},{"key":"2025121222105141000_13.4.e073415.23","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.3109\/0284186X.2012.762998","article-title":"Factors influencing primary care physicians\u2019 decision to order prostate-specific antigen (PSA) test for men without prostate cancer","volume":"52","author":"Hayat Roshanai","year":"2013","journal-title":"Acta Oncologica"},{"key":"2025121222105141000_13.4.e073415.24","first-page":"904","article-title":"What do general practitioners think and do about prostate cancer screening in Australia?","volume":"42","author":"Ilic","year":"2013","journal-title":"Aust Fam Physician"},{"key":"2025121222105141000_13.4.e073415.25","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-018009","article-title":"Primary goals, information-giving and men\u2019s understanding: a qualitative study of Australian and UK doctors' varied communication about PSA screening","volume":"8","author":"Pickles","year":"2018","journal-title":"BMJ Open"},{"key":"2025121222105141000_13.4.e073415.26","first-page":"22","article-title":"[Early detection of prostate cancer by PSA testing: the results of a qualitative study on barriers caused by physicians in Austria implementing informed decision making]","volume":"75","author":"Malli","year":"2013","journal-title":"Gesundheitswesen"},{"key":"2025121222105141000_13.4.e073415.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006367","article-title":"Doctors\u2019 approaches to PSA testing and overdiagnosis in primary healthcare: a qualitative study","volume":"5","author":"Pickles","year":"2015","journal-title":"BMJ Open"},{"key":"2025121222105141000_13.4.e073415.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0153299","article-title":"General practitioners\u2019 experiences of, and responses to, uncertainty in prostate cancer screening: insights from a qualitative study","volume":"11","author":"Pickles","year":"2016","journal-title":"PLoS One"},{"key":"2025121222105141000_13.4.e073415.29","doi-asserted-by":"crossref","DOI":"10.1177\/2333393617742282","article-title":"Employing a qualitative description approach in health care research","volume":"4","author":"Bradshaw","year":"2017","journal-title":"Glob Qual Nurs Res"},{"key":"2025121222105141000_13.4.e073415.30","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"2025121222105141000_13.4.e073415.31","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/nur.21768","article-title":"Characteristics of qualitative descriptive studies: a systematic review","volume":"40","author":"Kim","year":"2017","journal-title":"Res Nurs Health"},{"key":"2025121222105141000_13.4.e073415.32","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025121222105141000_13.4.e073415.33","unstructured":"Strauss AL , Juliet C . Basics of qualitatiive research: techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage Publications Inc, 1998."},{"key":"2025121222105141000_13.4.e073415.34","unstructured":"Crabtree B . Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications, 1999."},{"key":"2025121222105141000_13.4.e073415.35","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/j.0020-2754.1997.00505.x","article-title":"Evaluating qualitative research in social geography: establishing \u201crigour\u201d in interview analysis","volume":"22","author":"Baxter","year":"1997","journal-title":"Trans Inst Br Geog"},{"key":"2025121222105141000_13.4.e073415.36","unstructured":"Canadian Task Force on Preventive Health Care . Prostate cancer - 1000-person tool. 2019. Available: https:\/\/canadiantaskforce.ca\/tools-resources\/prostate-cancer-harms-and-benefits\/"},{"key":"2025121222105141000_13.4.e073415.37","first-page":"5","article-title":"A simple approach to shared decision making in cancer screening","volume":"24","author":"Schrager","year":"2017","journal-title":"Fam Pract Manag"},{"key":"2025121222105141000_13.4.e073415.38","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1038\/s41391-020-0227-1","article-title":"Shared decision making and prostate-specific antigen based prostate cancer screening following the 2018 update of USPSTF screening guideline","volume":"24","author":"Jiang","year":"2021","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"2025121222105141000_13.4.e073415.39","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1001\/jamainternmed.2019.0763","article-title":"Decision aids for prostate cancer screening choice: a systematic review and meta-analysis","volume":"179","author":"Riikonen","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2025121222105141000_13.4.e073415.40","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1037\/0278-6133.27.6.711","article-title":"Influence of a patient decision aid on decisional conflict related to PSA testing: a structural equation model","volume":"27","author":"Stephens","year":"2008","journal-title":"Health Psychol"},{"key":"2025121222105141000_13.4.e073415.41","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-073415","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:11:01Z","timestamp":1765606261000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-073415"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4,28]]},"published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1136\/bmjopen-2023-073415"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-073415","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]}}}