Using the example of prostate cancer screening, researchers tackle the question of whether overextended primary care clinicians should adopt guidelines developed primarily by specialists when there is limited direct evidence of benefit.
The authors argue there is no direct evidence that the benefits of starting PSA screening at age 40, as recently recommended by two specialty organizations, instead of the previously recommended age of 50. Although well-meaning, the specialty guidelines, they assert, distract primary care physicians from providing services with proven benefit and value for patients.
They note the US Preventive Services Task Force currently recommends delivering 35 adult preventive services, for which it found high certainty of moderate or high net benefit — services that investigators estimate require 7.4 hours a day to deliver. Given the limited time in a typically rushed primary care visit, the authors conclude there is insufficient evidence that the benefits of starting PSA screening at age 40 justifies the additional counseling time.
The researchers call on primary care professional societies to vet specialty guidelines using evidence-based processes to determine which belong in primary care, thus enabling physicians to focus on providing patients services with proven effectiveness and value.
Moreover, they call for primary care physicians and experts in evidence synthesis to participate on guideline review panels to ensure guidelines are based on systematic review of evidence and not solely on expert opinion.