Applying strategies from libertarian paternalism to decision making for prostate specific antigen (PSA) screening

BMC Cancer

Debate

David E Nelson¹  Konrad M Szymanski²  Amanda Black³  David C Wheeler⁴ 

[1] Cancer Prevention Fellowship Program Branch, Center for Cancer Training, National Cancer Institute, 20892, Bethesda, MD, USA;Division of Urology, McGill University Health Centre, Montreal, QC, Canada;Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 20892, Bethesda, MD, USA;Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 20892, Bethesda, MD, USA;

关键词: Prostate Cancer;    Prostate Specific Antigen;    Share Decision Making;    Default Option;    Prostate Cancer Screening;   

DOI  :  10.1186/1471-2407-11-148

 received in 2010-11-02, accepted in 2011-04-21,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundDespite the recent publication of results from two randomized clinical trials, prostate specific antigen (PSA) screening for prostate cancer remains a controversial issue. There is lack of agreement across studies that PSA screening significantly reduces prostate cancer mortality. In spite of these facts, the widespread use of PSA testing in the United States leads to overdetection and overtreatment of clinically indolent prostate cancer, and its associated harms of incontinence and impotence.DiscussionGiven the inconclusive results from clinical trials and incongruent PSA screening guidelines, the decision to screen for prostate cancer with PSA testing is an uncertain one for patients and health care providers. Screening guidelines from some health organizations recommend an informed decision making (IDM) or shared decision making (SDM) approach for deciding on PSA screening. These approaches aim to empower patients to choose among the available options by making them active participants in the decision making process. By increasing involvement of patients in the clinical decision-making process, IDM/SDM places more of the responsibility for a complex decision on the patient. Research suggests, however, that patients are not well-informed of the harms and benefits associated with prostate cancer screening and are also subject to an assortment of biases, emotion, fears, and irrational thought that interferes with making an informed decision. In response, the IDM/SDM approaches can be augmented with strategies from the philosophy of libertarian paternalism (LP) to improve decision making. LP uses the insights of behavioural economics to help people better make better choices. Some of the main strategies of LP applicable to PSA decision making are a default decision rule, framing of decision aids, and timing of the decision. In this paper, we propose that applying strategies from libertarian paternalism can help with PSA screening decision-making.SummaryOur proposal to augment IDM and SDM approaches with libertarian paternalism strategies is intended to guide patients toward a better decision about testing while maintaining personal freedom of choice. While PSA screening remains controversial and evidence conflicting, a libertarian-paternalism influenced approach to decision making can help prevent the overdiagnosis and overtreatment of prostate cancer.

【 授权许可】

CC BY   
© Wheeler et al; licensee BioMed Central Ltd. 2011