The shared clinical decision regarding the risks of prostate cancer screening
DOI:
https://doi.org/10.5712/rbmfc16(43)2470Keywords:
Prostatic Neoplasms, Health Communication, Decision Making, Shared, Quaternary Prevention.Abstract
Introduction: Current evidence shows an imbalance between benefits and harms with the prostate cancer screening, which can cause considerable risks to men’s health. This statement supports the recommendation of the Brazilian Health Ministry that recommends not to stimulate this practice and large discussion about the implications of these exams when the man requests it. Purpose: Analyze the perception and experience of men and doctors about sharing the decision in screening for prostate cancer. Method: A qualitative and exploratory study was carried out, from a focus group with men of mature age (average: 51 years) and semi-structured interviews with doctors in basic health units, from different states in Brazil. The data were systematized, grouped, and categorized by content analysis. Results: Men were unaware of the possible damages related to the prostate cancer screening, and we also identified personal, cultural barriers and the organization of work’s process, that showed to difficult clinical communication during consultation in primary health care. On the other hand, men report a desire for greater participation in the choices about their health, mentioning the internet as a tool used to reduce the knowledge gap in the clinical relationship. The findings also present strategies used by doctors, such as infographic and tools, which help to include different profiles of men in decision making. Conclusion: The investigation demonstrated that, although there are advances in relation to the debate about possible harmful implications of prostate cancer screening and examples of inclusive approaches, this practice is not consolidated in Brazil, revealing the need to disseminate actions that encourage the participation in the decisions that directly influence their quality of life and well-being. Thus, there is a need to invest in strategies that facilitate doctor/patient communication, in addition to expanding the debate on the implications of screening among professionals inserted in Primary Health care and in the population.
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(1) Hargraves IG, Montori VM, Brito JP, Kunneman M, Shaw K, LaVecchia C, et al. Purposeful SDM: A problem-based approach to caring for patients with shared decision making. Patient Education and Counseling. 2019;102(10):1786–92. https://doi.org/10.1016/j.pec.2019.07.020
(2) Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359. https:// doi: 10.1136/bmj.j4891
(3) Stewart M, Brown J, weston W, Mcwhiney I, Mcwillian C, Freeman T. Medicina centrada na pessoa: transformando o método clínico. 3o ed. Artmed; 2017.
(4) Brasil. Ministério da Saúde. Política Nacional de Humanização: PNH [Internet]. Brasília: Ministério da Saúde; 2013 [acesso 10 Nov 2020]. Disponível: https://bit.ly/2X37vvl
(5) Brasil. Ministério da Saúde. Política Nacional de Promoção da Saúde: PNPS [Internet]. Brasília: Ministério da Saúde; 2017 [acesso 15 Nov 2020]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2014/prt2446_11_11_2014.html
(6) Brasil. Portaria de consolidação. Política Nacional de Atenção Básica. Artigo 6o Anexo XXII [Internet]. Ministério da Saúde; 2017. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prc0002_03_10_2017.html
(7) Abreu MM de, Battisti R, Martins RS, Baumgratz TD, Cuziol M. Shared decision making in Brazil: history and current discussion. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen [Internet]. 2011;105(4):240–4. DOI: 10.1016/j.zefq.2011.04.009
(8) Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-Specific Antigen–Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA [Internet]. 2018;319(18):1914–31. DOI: 10.1001/jama.2018.3712
(9) Santos ROM, Ramos DN, de Assis M. Construção compartilhada de material educativo sobre câncer de próstata. Revista Panamericana de Salud Pública [Internet]. 2018; 42:1–8. https://doi.org/10.26633/RPSP.2018.122
(10) Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil [Internet]. Rio de Janeiro: Inca; 2015 [acesso 18 Ago 2020]. Disponível: https://bit.ly/3bPqKMP
(11) Instituto Nacional de Câncer José Alencar Gomes da Silva. Monitoramento das ações de controle do câncer de próstata. Informativo detecção precoce; 2017. Boletim ano 8, n.2, julho/ dezembro [acesso 11 Jan 2020]. Disponível: https://bit.ly/3bPqKMP
(12) Norman AH. Medical ethics and screening: on what evidence should we support ourselves? Revista Brasileira de Medicina de Família e Comunidade 2014 [citado 18 de abril de 2020];9(31):108–10. http://dx.doi.org/10.5712/rbmfc9(31)933
(13) Norman AH, Tesser CD. Prevenção quaternária: as bases para sua operacionalização na relação médico-paciente. Revista Brasileira de Medicina de Família e Comunidade. 2015; 10(35): 1-10, abr.-jun. https://doi.org/10.5712/rbmfc10(35)1011
(14) Norman AH, Tesser CD. Quaternary prevention: a balanced approach to demedicalisation. - [Internet]. British Journal of General Practice. 2019; 69 (678): 28-29. https://doi.org/10.3399/bjgp19X700517
(15) Tesser CD. Convergências entre prevenção quaternária e promoção da saúde. Revista Brasileira de Medicina de Família e Comunidade. 2020;15(42):2515–2515. DOI: https://doi.org/10.5712/rbmfc15(42)2515
(16) Santos ROM, Engstrom EM, Abreu MM. Minha vida, minha voz na decisão: decisão compartilhada no rastreamento do câncer de próstata. Tese de doutorado. [Rio de Janeiro, RJ]: Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca. 2020.
(17) Uwe Flick. Introdução à pesquisa qualitativa. 3a. Porto Alegre: Artmed; 2009.
(18) SCHEFFER, M. et al. Demografia médica no Brasil 2018. São Paulo, SP: FMUSP, CFM, Cremesp; 2018.
(19) Aronowitz R, Greene J. Contingent Knowledge and Looping Effects — A 66-Year-Old Man with PSA-Detected Prostate Cancer and Regrets. N Engl J Med. 2019; 381:1093-1096. https://doi.org/ 10.1056/NEJMp1811521
(20) Minossi JG, Silva AL da. Medicina defensiva: uma prática necessária? Rev. Col. Bras. Cir. [online]. 2013, vol.40, n.6, pp.494-501. https://doi.org/10.1590/S0100-
(21) Vale HM do, Miyazaki MC de OS, Vale HM do, Miyazaki MC de OS. Medicina defensiva: uma prática em defesa de quem? Revista Bioética. 2019;27(4):747–55. http://doi.org/10.1590/1983-80422019274358
(22) Vasconcelos C. Responsabilidade médica e judicialização na relação médico-paciente. Revista Bioética. [internet]. 2012;20(3) [acesso 11 Jan 2020]. Disponível em: http://revistabioetica.cfm.org.br/index.php/revista_bioetica/article/view/757
(23) Laguardia J, Martins MS, Barcellos GB. Qualidade do cuidado em saúde e a iniciativa “Choosing Wisely”. RECIIS (Online). 2016; 10(1):1-8. https://doi.org/10.29397/reciis.v10i1.1097
(24) Silva CID. Quando o antígeno específico da próstata nos leva ao Balint: um relato de caso. Revista Brasileira de Medicina de Família e Comunidade. 2017;12(39):1–6. https://doi.org/10.5712/rbmfc12(39)1518
(25) Santos ROM dos, Romano VF, Engstrom EM. Vínculo longitudinal na Saúde da Família: construção fundamentada no modelo de atenção, práticas interpessoais e organização dos serviços. Physis [online]. 2018, vol.28, n.2. http://dx.doi.org/10.1590/s0103-73312018280206.
(26) Légaré F, Thompson-Leduc P. Twelve myths about shared decision making. Patient Education and Counseling. 2014;96(3):281–6. https://doi.org/10.1016/j.pec.2014.06.014
(27) Scalia P, Durand M-A, Faber M, Kremer JA, Song J, Elwyn G. User-testing an interactive option grid decision aid for prostate cancer screening: lessons to improve usability. BMJ Open. 2019;9(5): https://doi.org/ 10.1136/bmjopen-2018-026748
(28) Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2017. https://doi.org/10.1002/14651858.CD001431.pub5/full
(29) Steffensen KD, Vinter M, Crüger D, Dankl K, Coulter A, Stuart B, et al. Lessons in Integrating Shared Decision-Making Into Cancer Care. J Oncol Pract. 2018;14(4):229–35. https://doi.org/10.1200/JOP.18.00019
(30) Iverson SA, Howard KB, Penney BK. Impact of Internet Use on Health-Related Behaviors and the Patient-Physician Relationship: A Survey-Based Study and Review. J Am Osteopath Assoc 2008;108(12):699–711. [acesso em 11 Jan 2020]. Disponível em: https://europepmc.org/article/med/19075034
(31) Carneiro B, Dizon DS. Prostate Cancer Social Media: In YouTube We Trust? Eur Urol. 2019;75(4):568–9. https://doi.org/10.1016/j.eururo.2019.01.004
(32) Loeb S, Sengupta S, Butaney M, Macaluso JN, Czarniecki SW, Robbins R, et al. Dissemination of Misinformative and Biased Information about Prostate Cancer on YouTube. European Urology. 2019;75(4):564–7. https://doi.org/10.1016/j.eururo.2018.10.056
(33) Nunes FDBRS, Almeida A das DL de. Informação médica e consentimento de pessoas com câncer. Revista Bioética. 2018;26(1):119–26. https://doi.org/10.1590/1983-80422018261233
(34) Pieterse AH, Stiggelbout AM, Montori VM. Shared Decision Making and the Importance of Time. JAMA [Internet]. 2019;322(1):25–6. https://doi.org/10.1001/jama.2019.3785
(35) Marques Filho J, Hossne WS. A relação médico-paciente sob a influência do referencial bioético da autonomia. Revista Bioética. 2015;23(2):304–10. https://doi.org/10.1590/1983-80422015232069
(36) Hahlweg P, Witzel I, Müller V, Elwyn G, Durand M-A, Scholl I. Adaptation and qualitative evaluation of encounter decision aids in breast cancer care. Arch Gynecol Obstet. 2019;299(4):1141–9. https://doi.org/10.1007/s00404-018-5035-7
(37) Menear M, Garvelink MM, Adekpedjou R, Perez MMB, Robitaille H, Turcotte S, et al. Factors associated with shared decision making among primary care physicians: Findings from a multicentre cross-sectional study. Health Expect. 2018;21(1):212–21. https://doi.org/10.1111/hex.12603
(38) Hajizadeh N, Uhler LM, Pérez Figueroa RE. Understanding patients’ and doctors’ attitudes about shared decision making for advance care planning. Health Expect. dezembro de 2015;18(6):2054–65. https://doi.org/10.1111/hex.12285
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Copyright (c) 2021 Renata Oliveira Maciel dos Santos, Mirhelen Mendes de Abreu , Elyne Montenegro Engstrom
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