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Will men attribute fault to their GP for adverse effects arising from controversial screening tests? An Australian study using scenarios about PSA screening

Objective: To determine men's attribution of fault for adverse consequences of prostate-specific antigen (PSA) screening. Setting: Representative, population-based sample recruited from Sydney, Australia (n=405). Methods: Telephone interview to assess reactions to two scenarios: Scenario 1, depicting a GP who dismisses an opportunity to order a PSA test (missed diagnosis); and Scenario 2, depicting a GP who recommends PSA screening to a patient who then experiences adverse outcomes from treatment of his prostate cancer (iatrogenic consequences). Results: Two-thirds of participants (66.9%) ascribed fault to the GP in Scenario 1. Men in fair or poor health (adjusted odds ratio [AOR] 1.81; 95% confidence interval [CI] 1.04–3.12; p=0.03) and those with better knowledge about PSA screening (AOR 0.98; 95% CI 0.97–0.99; p=0.002) were significantly and independently more likely to ascribe fault in Scenario 1. By contrast, only 15.8% of participants ascribed responsibility to the GP in Scenario 2. Older men (AOR 1.05; 95% CI 1.00–1.10; p=0.04) and those with higher levels of decisional conflict (AOR 1.19; 95% CI 1.04–1.37; p=0.01) were significantly and independently more likely to ascribe responsibility. Conclusion: Public education could better target men's tendency to ascribe fault to GPs when they miss an opportunity to diagnose prostate cancer early through PSA screening, even though the corollary of potential iatrogenic consequences is perceived as less blameworthy. As decisional conflict and knowledge were found to predict attribution of fault, evidence-based information may reduce the medicolegal volatility of this controversy.