Decision Fatigue in Low-Value Prostate Cancer Screening
| Autor: | Heidi A. Hanson, Jacob P. Ambrose, Benjamin Haaland, Kensaku Kawamoto, Christopher Dechet, William T. Lowrance, Brock O'Neil, Trevor C. Hunt |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Article 03 medical and health sciences Appointments and Schedules 0302 clinical medicine Interquartile range Medicine Decision fatigue Humans Mass Screening 030212 general & internal medicine Family history Early Detection of Cancer Fatigue Aged business.industry Medical record Health services research Prostatic Neoplasms Odds ratio Middle Aged Prostate-Specific Antigen Prostate-specific antigen Prostate cancer screening Oncology 030220 oncology & carcinogenesis Emergency medicine business |
| Zdroj: | Cancer |
| Popis: | BACKGROUND Low-value prostate-specific antigen (PSA) testing is common yet contributes substantial waste and downstream patient harm. Decision fatigue may represent an actionable target to reduce low-value urologic care. The objective of this study was to determine whether low-value PSA testing patterns by outpatient clinicians are consistent with decision fatigue. METHODS Outpatient appointments for adult men without prostate cancer were identified at a large academic health system from 2011 through 2018. The authors assessed the association of appointment time with the likelihood of PSA testing, stratified by patient age and appropriateness of testing based on clinical guidelines. Appointments included those scheduled between 8:00 am and 4:59 pm, with noon omitted. Urologists were examined separately from other clinicians. RESULTS In 1,581,826 outpatient appointments identified, the median patient age was 54 years (interquartile range, 37-66 years), 1,256,152 participants (79.4%) were White, and 133,693 (8.5%) had family history of prostate cancer. PSA testing would have been appropriate in 36.8% of appointments. Clinicians ordered testing in 3.6% of appropriate appointments and in 1.8% of low-value appointments. Appropriate testing was most likely at 8:00 am (reference group). PSA testing declined through 11:00 am (odds ratio [OR], 0.57; 95% CI, 0.50-0.64) and remained depressed through 4:00 pm (P |
| Databáze: | OpenAIRE |
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