Barriers and facilitators of discussion
| Determinant | Description |
|---|---|
| Facilitator | |
| Professional role to inform patients | “Patients deserve to have information to make their decision … I just think that’s part of family doctor’s role, is not to make the decision for the patient but to explain to them you know, what the guidelines are, what the reasons are for that. Patients still have an opportunity to make a decision for themselves with the right information.” — Participant 012 |
| Beliefs about capabilities or skills for discussion to support patient choice or explain why screening not optimal for a specific patient | “I guess I’m kind of used to having wishy washy conversations because you know PSAs are kind of like that too right? And like when people are deciding whether to go for FIT testing versus a colonoscopy like there’s no black and white answer there. It’s just sort of explaining what the risks and benefits are of all the different options.” — Participant 010 “I would say most of the time I do not have difficulties … I think most, like I would say 98% of the women I’ve spoken to, as long as I sit down and give them a proper explanation, and sometimes I would even refer them to Task Force. Most of them were very satisfied and don’t bring it up again.” — Participant 016 |
| Barriers | |
| Incomplete knowledge of benefits and harms | “I think overdiagnosis for me is a false positive, where they’re seeing things that are just related to a younger patient being put through a protocol that’s been tested really on older patients. So to me, overdiagnosis is that, like, a positive result that comes back to being nothing, but causes anxiety.” — Participant 003 |
| Beliefs about consequences | Some providers felt that harms will sway women against screening. “I guess there’s the risk of benign call-back false positives, the biopsy, the discomfort, the anxiety, the fear, but you know, I’m not going to tell somebody, “Oh, you might have a false positive and you’re going to put yourself through hell for nothing.” I don’t see that as such a big event … I wouldn’t put that scenario as the most likely thing for them so that they’re afraid to go in.” — Participant 005 |
| Skills to explain why or when screening not required. | Providers who had this knowledge of why or when screening was not required had the skill to explain this to patients, but this was a barrier without that specific knowledge. |
Note: FIT = fecal immunochemical test, PSA = prostate-specific antigen.