Determinants of prostate-specific antigen test use in prostate cancer screening by primary care physicians

Objective: To identify determinants of prostate-specific antigen (PSA) test use in prostate cancer screening by primary care physicians. Design: Self-administered, confidential surveys were mailed to 800 Ohio primary care physicians. A second mailing to nonrespondents was sent a month later. Surveys included questions on beliefs, attitudes, knowledge, and reasons for PSA prostate cancer screening. Results: The response rate of usable surveys was 51% (n=408). More than half (55%) of the respondents reported using the PSA test for screening often or always. Multiple regression analysis showed physicians' reported belief that PSA screening is the standard of care in one's community was the strongest direct predictor of use (beta=.32; P<.001). Other direct predictors of PSA test use included physician feeling about the test (beta=.28; P<.001), patient requests for the test (beta=.19; P<.001), age of patient (beta=.11; P less than or equal to.003), and recommendation of specialty or other organizations (beta=.12; P=.001). Conclusions: Although PSA prostate cancer screening has yet to be proved definitely effective in decreasing mortality or morbidity from the disease, more than half of Ohio primary care physicians surveyed reported regular screening. The rationale for such screening seems to be multifaceted, and, thus, changes in physician behavior probably will be difficult to achieve.