Older men whose clinician was a physician trainee had substantially lower prostate-specific antigen (PSA) screening rates than those with an attending physician, nurse practitioner, or physician assistant as their clinician, a study published in JAMA Internal Medicine has shown.1
Despite guideline recommendations advising against PSA screening in older men with a limited life expectancy, PSA screening remains common in this patient population. Therefore, researchers sought to identify clinician characteristics associated with PSA screening rates in older veterans according to life expectancy.
For this cross-sectional study, researchers analyzed data from 826 286 veterans aged 65 years or older who had laboratory tests performed in the VA health care system in 2011. Limited life expectancy was defined as age of at least 85 years with Charlson comorbidity score of 1 or greater or age of at least 65 years with Charlson comorbidity score of 4 or greater.
In 2011, 56% of the older veterans received PSA screening, including 39% of the 203 717 men with limited life expectancy. Researchers found that higher PSA screening rates in patients with limited life expectancy was associated with having a clinician who was an older male and was no longer receiving training.
Results showed that 27% of men with a physician trainee received PSA screening compared with 42% of men with an attending physician (P< .001). A total of 22% of men with a geriatrician vs 82% of men with a urologist as their clinician underwent PSA screening (P < .001), while 29% of those with a clinician 35 years or younger had screening vs 41% of those with a clinician 56 years or older (P < .001). Furthermore, the PSA screening rates ranged from 38% for men with a female clinician older than 55 years to 43% for men with a male clinician older than 55 years (P < .001).
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The findings ultimately suggest that interventions to reduce PSA screening rates in older men with limited life expectancy should be designed to target older male, nontrainee clinicians to achieve the greatest impact.
- Tang VL, Shi Y, Fung K, et al. Clinician factors associated with prostate-specific antigen screening in older veterans with limited life expectancy [published online ahead of print April 4, 2016]. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.0695.