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© 2004 American Public Health Association
RESEARCH AND PRACTICE |
Evelyn C. Y. Chan and Chul Ahn are with the Division of General Internal Medicine, University of Texas–Houston Medical School. Sally W. Vernon is with the Center for Health Promotion and Prevention Research, University of Texas–Houston School of Public Health. Anthony Greisinger is with Kelsey Research Foundation and Kelsey-Seybold Clinic, Houston, Tex.
Correspondence: Requests for reprints should be sent to Evelyn C. Y. Chan, MD, Biomedical Ethics, Division of General Internal Medicine, University of Texas–Houston Medical School, 6431 Fannin, 1.122 MSB, Houston, TX 77030 (e-mail: evelyn.c.chan{at}uth.tmc.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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This study determined the accuracy of self-reports of prostatespecific antigen (PSA) testing. Men (N = 402) attending 2 outpatient clinics were asked: "Did you have a PSA test today?" and their medical records were checked. Concordance, sensitivity, and false-negative values were 65%, 67%, and 33%, respectively, at 1 clinic site and 88%, 64%, and 36% at the other. The accuracy of self-reports of PSA testing should be interpreted with caution.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Screening for prostate cancer with prostate-specific antigen (PSA) is controversial because it is not clear whether regular testing reduces mortality.1–5 Therefore, professional organizations recommend informed decisionmaking for PSA testing.6–10 To promote educational efforts for informed decisionmaking and to determine screening prevalence, which often relies on selfreported data, investigators need data on the accuracy of self-reports of PSA testing. We hypothesized that the accuracy of self-reports of PSA testing would be high if patients were asked about testing on the same day as their clinic visit. We determined whether any demographic, knowledge, or experience variables predicted accurate self-reports.
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Study participants were enrolled in another study11 and attended the general internal medicine outpatient clinics at Kelsey-Seybold Clinic in Houston, Tex, and the University of Texas–Houston. Men attending KelseySeybold Clinic were scheduled for an annual health maintenance examination. Men attending the University of Texas–Houston were scheduled for nonurgent care visits.
From April to July 2001, we approached 677 men aged 50 years or older on-site after they had visited with their physician. To be eligible, men had to have no history of prostate cancer and at least a sixth-grade education. Ninety men were ineligible, and 157 refused to participate, resulting in a sample of 430 men. Each participant was paid $10 to complete a self-administered survey. A medical record review between January and March 2002 by an internal medicine physician was used as the gold standard to determine whether men had received a PSA test with their visit. After participants with unavailable records were excluded, 265 men from Kelsey-Seybold Clinic and 137 men from the University of Texas–Houston remained.
We used sections of a survey from another study.11 The main dependent variable was concordance12 of patient self-reports of PSA testing to the following question: "Did you have a PSA test today?" Independent variables were demographic, knowledge, and experience variables.
We excluded from our analysis 46 men at Kelsey-Seybold Clinic (17%) and 7 men from the University of Texas–Houston (5%) who responded "don’t know" to "Did you have a PSA test today?"
We conducted 
2 tests to describe the demographic characteristics of the respondents and to assess the accuracy of PSA self-reports for independent variables. Variables significant at P 
.25 were entered into a stepwise logistic regression model to identify the predictors of accurate self-reports at each site.11,12
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Respondents at the Kelsey-Seybold Clinic had a higher annual household income than did respondents at the University of Texas–Houston but otherwise had similar demographic characteristics (Table 1
).
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In response to the question "Did you have a PSA test today?" at Kelsey-Seybold Clinic, 145 men responded "yes" and 74 men responded "no." At the University of Texas–Houston, 25 men responded "yes" and 105 men responded "no." The concordance was 65% at Kelsey-Seybold Clinic and 88% at the University of Texas–Houston. The sensitivity and false-negative values were 67% and 33%, respectively, at Kelsey-Seybold Clinic and 64% and 36%, respectively, at the University of Texas–Houston. The specificity and false-positive values were 43% and 57%, respectively, at KelseySeybold Clinic and 98% and 2%, respectively, at the University of Texas–Houston.
At Kelsey-Seybold Clinic, 5 variables were significantly associated with accurate self-reports of PSA testing: (1) more education, (2) "ever heard of a PSA," (3) "ever been told to have a PSA," (4) "ever had a PSA," and (5) "doctor recommended a PSA today" (Table 2).
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The prevalence of PSA testing was 90% at Kelsey-Seybold Clinic and 28% at the University of Texas–Houston by medical record review. Among the 53 men who responded "don’t know" to the question "Did you have a PSA test today?", the prevalence of PSA testing was 91% at Kelsey-Seybold Clinic and 28% at the University of Texas–Houston. Among the 220 men who responded "yes" to the question "Did your doctor recommend a PSA test today?", the prevalence of PSA testing was 93% at Kelsey-Seybold Clinic and 64% at the University of Texas–Houston. Among the 146 men who responded "yes" to the question "Did your doctor discuss the advantages and disadvantages of the PSA test with you?", the prevalence of PSA testing was 88% at Kelsey-Seybold Clinic and 38% at the University of Texas–Houston.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Our findings and those of others13,14 suggest that the sensitivity of asking a man whether he had completed a PSA test is relatively low, regardless of the time frame for self-reporting a test. We found a false-negative response rate of one third, which is of concern because of the potential harm that may arise when men must cope with the consequences of a test that they did not even realize they had taken. Because professional organizations recommend informed decisionmaking before PSA testing, future studies should focus on improving physician–patient communication. We recommend caution when interpreting the accuracy of self-reports of PSA testing.
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Acknowledgments |
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This study was funded by National Cancer Institute grant K08-CA78615, awarded to Dr Chan as a clinical scientist award, and by Centers for Disease Control and Prevention/Association of Schools of Public Health grant S1171-19/20. Additional technical support was provided by National Institutes of Health grant M01-RR02558 to the Clinical Research Center at The University of Texas–Houston.
This brief was presented at the annual meeting of the American Public Health Association, San Francisco, Calif, November 17, 2003.
We appreciate the assistance of Dr Donnie Aga of Kelsey-Seybold Clinic, Houston, Tex.
Human Participant Protection
The study was approved by the institutional review board of The University of Texas–Houston Health Sciences Center.
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Footnotes |
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Contributors
E. C. Y. Chan supervised the study and with S. W. Vernon conceived the study design and collected and analyzed the data. C. Ahn analyzed the data. A. Greisinger assisted with data collection. All authors contributed to revisions of the brief and approved the final version.
Accepted for publication November 6, 2003.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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1. Harris R, Lohr KN. Screening for prostate cancer: an update of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2002;137:917–929.
2. Burack RC, Wood DP Jr. Screening for prostate cancer: the challenge of promoting informed decision making in the absence of definitive evidence of effectiveness. Med Clin North Am. 1999;83:1423–1442.[Web of Science][Medline]
3. Coley CM, Barry MJ, Fleming C, Mulley AG. Early detection of prostate cancer, part I: prior probability and effectiveness of tests. The American College of Physicians. Ann Intern Med. 1997;126:394–406.
4. Woolf SH. Screening for prostate cancer with prostate-specific antigen: an examination of the evidence. N Engl J Med. 1995;333:1401–1405.
5. Brawley OW. Prostate cancer screening: a note of caution. In: Thompson IM, Resnick MI, Klein EA, eds. Prostate Cancer Screening. Totowa, NJ: Humana Press Inc; 2001:175–185.
6. American College of Physicians. Screening for prostate cancer. Ann Intern Med. 1997;126:480–484.
7. American Cancer Society. Summary of American Cancer Society recommendations for the early detection of cancer in asymptomatic people. In: Cancer Facts & Figures 2001. Atlanta, Ga: National Home Office: American Cancer Society Inc; 2001:35.
8. American Academy of Family Physicians. Introduction to AAFP summary of policy recommendations for periodic health examination. Available at: http://www.aafp.org/policy/camp/apndx_fc.html. Accessed July 10, 2001.
9. American Urological Association. Prostatespecific antigen (PSA) best practice policy. Oncology. 2002;14:267–272.
10. US Preventive Services Task Force. Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002;137:915–916.
11. Chan ECY, Vernon SW, O’Donnell FT, Ahn CW, Greisinger A, Aga DW. How well are men getting the public health message about informed consent for prostate cancer screening with prostate specific antigen? Am J Public Health. 2003;93:779–785.
12. Hosmer DW Jr, Lemeshow S. Applied Logistic Regression. 2nd ed. New York, NY: John Wiley & Sons Inc; 2000.
13. Jordan TR, Price JH, King KA, Masyk T, Bedell AW. The validity of male patients’ self-reports regarding prostate cancer screening. Prev Med. 1999;28:297–303.[Web of Science][Medline]
14. Volk RJ, Cass AR. The accuracy of primary care patients’ self-reports of prostate-specific antigen testing. Am J Prev Med. 2002;22:56–58.[Web of Science][Medline]
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