Project 5: Prostate screening from the perspective of citizens

Work by Chris Degeling, in collaboration with Lucie Rychetnik and Stacy Carter

PSA testing to screen healthy men for prostate cancer risk is a controversial topic. Different groups in the community, and different professional groups, take very different positions on whether, and how, men should be tested. Often the debates over this question can become heated, and it is difficult to see how the issue can be resolved. Policy problems like this are well-suited to deliberation in a community jury.

Community juries are a lot like juries in a court room. They are made up of about a dozen people, who meet over two days. They hear expert testimony and then deliberate to make a decision about what they think is the right thing to do. The Community Jury process is an effective way to involve citizens in developing a thoughtful, well-informed solution to a public problem or issue. On the final day of their moderated hearings, the members of the Community Jury vote on the issues and present their recommendations to the public.


WHO WAS IN THE COMMUNITY JURIES

We held three separate juries in Sydney between July and Dec 2014.  All juries were held at the University of Sydney.

Forty members of the public were purposively selected from responders to public advertisements in Sydney to participate. Juries were comprised community members of a range of ages from diverse social and cultural backgrounds. People with recent experience [themselves or a close family member] of prostate cancer treatment, biopsy investigation or active PSA monitoring were excluded.


THE QUESTIONS PUT TO THE JURIES

Consent and PSA testing for prostate cancer: What should happen before men decide whether or not to be tested?

PART A: Select 1 or 2

  1. Should GPs introduce the topic of PSA testing during appointments with male patients who have no symptoms?

OR

  1. Should they wait until men ask about it?

 

PART B:

Which of these options do you endorse? (Please give your reasons)

  1. Men without symptoms should get all the information about the possible benefits and harms of testing, and biopsy and treatment, before they decide whether or not to have a PSA test.

OR

  1. Men should not get information about possible benefits and harms of biopsy and treatment before PSA testing. Instead, the doctor should wait until they know the test result. If the test result is raised, then the doctor should give information.

 


THE EXPERTS AND THE EVIDENCE PRESENTED TO THE JURIES

Expert 1

Prof Jenny Doust – The Basic Science of Prostate Cancer

jenny 2009

Professor Doust is Professor of Clinical Epidemiology in the Centre for Research in Evidence Based Practice at Bond University. She has trained and worked as a general practitioner, clinical epidemiologist and economist. She works as a general practitioner in Brisbane and is a member of the Pharmaceutical Benefits Advisory Committee, the Economic Sub-Committee of the Pharmaceutical Benefits Advisory Committee, the Cochrane Collaboration working group on Systematic Reviews of Diagnostic Test Accuracy, and was previously chair of the RACGP working group for the curriculum review of Chronic Conditions and chair of the Thomas C Chalmers award for the Cochrane Collaboration. Her main research areas of interest are diagnosis, screening and monitoring tests in general practice.

Topic Summary:

  • What prostate cancer is
  • Types of prostate cancer
  • Symptoms
  • How it is diagnosed
  • Treatment
  • Who is at risk

To watch Prof Doust’s presentation to the jury please hit this link


Expert 2

Ms Kristen Pickles – GP’s perspectives on PSA tests for Prostate Cancer

Kristen Pickles

Kristen Pickles is a PhD student at the Centre for Values, Ethics, and the Law in Medicine (VELiM) at the University of Sydney. She is a member of a cancer screening research team funded by the National Health and Medical Research Council (NHMRC). Kristen’s PhD is investigating general practitioners’ reasoning about, and approaches to, PSA testing of asymptomatic males for prostate cancer. Her background is in psychology and public health. Other research interests include overdiagnosis, qualitative research, public health ethics, and doctor-patient communication and decision-making.

Topic Summary

  • PSA testing and General Practice
  • 4 common approaches to PSA testing
  • The burdens PSA testing places on GPs

To watch Kristen’s presentation to the jury please hit this link


Expert 3

Dr Ainsley Newson – Ethical and Legal Perspectives on Screening for Disease

Bristol University Subtext Magazine 17th December 2007

Dr Ainsley Newson is Senior Lecturer in Bioethics at the University of Sydney. Trained in science, law and bioethics, she has worked in the field for over 15 years. Ainsley coordinates the Sydney Bioethics Program of coursework degrees in bioethics. Her research interests focus on ethical issues in emerging genetic and reproductive technologies. She is also interested in the practice of clinical ethics support; that is providing assistance to those requiring ethical input in a health service environment. Ainsley has published her work in a wide range of academic journals and books, and she also enjoys engaging more widely about her work.

Topic Summary

  1. Consent: what is it?
  2. Why should we care, ethically, about consent?
  3. What is needed for consent to be ‘ethical’?
  4. Can consent give rise to any problems in its ethical application in clinical
    practice?

To watch Dr Newson’s presentation to the jury please email her at ainsley.newson[at]sydney.edu.au


Expert 4

Prof Paul Glasziou – Evidence-based-medicine Perspectives on the PSA test

pglaszio

Paul Glasziou FRACGP, PhD is Professor of Evidence-Based Medicine at Bond University and a part-time General Practitioner. He was the Director of the Centre for Evidence-Based Medicine in Oxford from 2003-2010. His key interests include identifying and removing the barriers to using high quality research in everyday clinical practice. He is the author of six books related to evidence based practice: Systematic Reviews in Health Care, Decision Making. He has authored over 160 peer-reviewed journal articles and is the recipient of an NHRMC Australia Fellowship which he commenced at Bond University in July, 2010.

Topic Summary:

  • What do authorities say about prostate cancer screening
  • What is the problem with the PSA test?
  • How might testing harm you?
  • Screening versus not screening compared
  • Different outcomes for different men

To watch Prof Glasziou’s presentation to the jury please hit this link


Expert 5

Prof Robert ‘Frank’ Gardiner – Urological Perspectives on the PSA test

FRANK

Professor Gardiner holds appointments at the School of Medicine University of Queensland. He is a Professor of Medicine at the University of Queensland, an Affiliate Professor at the University of Queensland Centre for Clinical Research & a Consultant Urologist, Royal Brisbane and Women’s Hospital, Brisbane, Australia. He is an academic urologist with an established background in prostate cancer research who has been instrumental in supporting the development of a strong research culture in Urology in Australia and in developing collaborative research programs between clinicians, molecular and behavioural scientists such that Queensland is now pre-eminent in Urological Research in Australasia.  Major achievements and awards include: Membership of the Order of Australia (AM), Fellow of the Urological Society of Australia and New Zealand, over 175 peer-reviewed manuscripts in Urology and Urological Research and Chief Investigator on numerous locally, nationally and internationally funded research grants.

Topic Summary:

  • PSA & detecting Prostate cancer
  • Basis by which value of PSA screening for Prostate Cancer is determined
  • Assessment of those screening trials available
  • Patient Centred Outcomes
  • Making a Personal Decision

To watch Prof Gardiner’s presentation to the jury please hit this link


This study was funded by the Australian National Health and Medical Research Council (Project 1023197) and run by the Centre for Values, Ethics and the Law in Medicine at the University of Sydney. The chief investigator for the study was A/Prof Stacy Carter, and the study wa managed by Dr Chris Degeling.

More information about Chris here

More about Lucie here

More information about Stacy here

You can read more about these studies in the following publications:

Degeling C, Carter SM, and Rychetnik L. Which public and why deliberate? – A scoping review of public deliberation in public health and health policy research.  Social Science & Medicine 2015;131:114-21.

Degeling C, Rychetnik L, Pickles K, Doust J, Gardiner R, Glasziou P, Newson A, Thomas R, Carter S. “What should happen before asymptomatic men decide whether or not to have a PSA test?” A report on three community juries. Medical Journal of Australia, 2015, 203(8), 335

Degeling C, Carter SM, Rychetnik L. All care, but whose responsibility? Community juries reason about expert and patient responsibilities in prostate-specific antigen screening for prostate cancer. Health. 2016;20(5):465-84.