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Invited Commentary
Mar 11, 2013

Bridging the Gap at the Center of Patient Centeredness: Individual Patient Preferences in Health Care Decision Making: Comment on “Comparing 3 Techniques for Eliciting Patient Values for Decision Making About Prostate-Specific Antigen Screening”

Author Affiliations

Author Affiliations: Health Services Research and Development Service, Office of Research and Development, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, and Departments of Psychiatry and Urology, University of California at San Francisco.

JAMA Intern Med. 2013;173(5):369-370. doi:10.1001/jamainternmed.2013.3370

Patient-centered care has been identified as one of 6 aims to achieving the health care system quality aspired to in the 21st century. It is described as health care that is “respectful and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions.”1

During the past decade, the importance of using individual patient values and preferences to guide cancer screening decisions has become clear, and the use of prostate-specific antigen (PSA) testing to screen for prostate cancer is a case in point.2-4 The PSA screening decision has been known as a preference-sensitive decision, in which several alternatives exist and complex trade-offs between the risks and benefits of each alternative must be weighed in making the choice. This choice is complicated by the low sensitivity and specificity of the PSA test and by the risk of significant harms associated with screening, such as false-positive results, pain associated with biopsy, and incontinence, sexual dysfunction, and other morbidities associated with prostate cancer treatment. Not being screened for prostate cancer is an alternative currently recommended for men of all ages by the US Preventive Services Task Force, but it is associated with its own risks, including the potential for anxiety. Thus, to achieve patient-centeredness in PSA screening decisions, each man's values and preferences based on weighing these complex risks of harms and the potential benefits of PSA testing would be used to guide his choices and the health care he receives.

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