By Kelli Deeter
I was intrigued by Daniel Stone on THCB entitled in May “The diagnosis of cancer as a” bides “learning moment. In my practice as a sign -certified nurse, I am often asked about prostate -specific antigen (PSA) tests by my male patients.
Nursing practice and medical practice are often blurred or merged. In the state of Colorado, nurses practice their own license and patients can diagnose and treat independently. In some institutions where I worked, I noticed that I often corrected patients who refer to me as a ‘doctor’. “I am not a doctor, I am a nurse,” I am repeated multiples a day. In this discussion of PSA tests I want to share my decisions to order PSA tests for individuals or not, based on my nursing training.
It is important to refer to the Guidelines for PSA tests recommended by the US Preventive Services Task Force (USPSTF), and published by The Journal of the American Medical Association (Jama). The latest updates for the guidelines were in 2018. It is the key to remember that these are guidelines and that doctors, doctors’ assistants and nurses use these guidelines in their consideration of the patient. In nursing, a holistic and team approach with the preferences of the patient, history, cultural considerations and the desired outcome are all weighed in decision -making for assessment, testing, referral and treatment. Guidelines are exactly that, a guide, not absolute.
Guidelines state that for patients aged 55-69: Screening offers a small potential advantage of reducing the risk of death due to prostate cancer in some men. However, many men will experience possible damage to screening, including false-positive results that require extra tests and possible prostate biopsy; overdiagnosis and over treatment; And treatment complications, such as incontinence and erectile dysfunction … Doctors are not allowed to screen men who do not prefer screening. And for patients aged 70 and older: the USPSTF recommends against PSA-based screening on prostate cancer. This does not mean that we as providers do not have to test men younger than 55 or older than 70. We have to view every patient cabinet independently of each other and not merge everyone.
Moreover, patients may not know how to “express a preference for screening”. Het is absoluut noodzakelijk dat providers de toegewezen tijd hebben om hun familiegeschiedenis van prostaat en andere kankers te verkennen, hen de voordelen en risico’s van testen uit te leggen, te luisteren en te bespreken en te bespreken van hun tekenen en symptomen, een digitaal rectaal examen (DRE) uitvoeren (DRE), indien van toepassing en overeengekomen door de patiënt, rekening houdend met hun medicatie, hun medicatie, en hun medicatie, ook als ze een behandeling willen Or not. Certainly, if they are symptomatic, and a new drug is prescribed for their symptoms, or if it is symptomatic and a Dre is obtained that is abnormal, a PSA must be obtained with the approval of the patient to determine a basic line and made a follow -up appointment with repeated laboratories or reference, if desired by the patient. If there is a family history of prostate cancer, an early PSA screening test to determine a basic line may be preferred. Again, patient preferences must be taken into account.
People have very different feelings about Western medicine and what they want for themselves and their bodies. We have to realize that only because someone has an ever -increasing PSA with or without symptoms, they may not agree with a Dre or referral to urology, surgery or oncology. As a provider we must receive a refusal of recommended care. It’s ok not to want to test, follow-up or treatment, regardless of someone’s age. In the case of Biden there was no PSA tests since 2014 during his vice -presidency. The fact that no reason was given is not relevant, in 2014 he was 72 years old. The guidelines are not to test from the age of 70. The PSA level if drawn may not have established its health results or treatment, but it may have influenced the outcome of his nomination for the presidency, which is politized to nurse and medical practice. Watching fingers now in the past does nothing change. I agree with Stone that this is a learning moment: arguing for yourself as a patient, arguing for your patient as a provider, and think that so much of a person’s health is a personal choice and that it must be honored and protected.
I agree Peter Attia’s statement in his 24 May 2024, a timely although tragic lesson about screening on prostate cancerthat the PSA screening guidelines are outdated; The last revision was in 2018. Attia indicates that many men stay healthy and far beyond the age of 80 live, and aggressive cancers when they are caught and treated early, the quality of life of the patient and the duration of life will better benefit. I would also claim that this is true for screening earlier in life, at the age of 50. Access to health care is a problem for many in our society. Marginalized populations such as the needy, homeless, geriatric, mentally ill and locked up perceived larger differences, and have a higher risk of missing PSA tests at all. In my work as a nurse in the correction system, this is often the first time they have ever seen a care provider for people who enter prisons and prisons. These individuals often have a history of inhophence, homelessness and/or mental disorders. Supplementary, New diagnoses of cancer are increasing and for men; 29% of the new cancer types are prostate.
Age 50 is a milestone for most individuals, and they know that they should receive screening on colorectal cancer at this age, as well as other screening tests. Consolidating care by recording a PSA at the same time would create an early basin line; There is never a guarantee that a patient with healthcare access problems will ever return for another appointment, because of finance, transport, anxiety or other factors. Another consideration for revising the PSA screening guidelines is to lower the threshold for PSA -Effairs based on the age of the patient That reference to urology for imaging, and the placement of simple language in the guidelines to view a double increase in PSA over 6-12 weeks as a probably urgent reference to urology. Initiating early vigilant waiting with PSA screening has the potential to save more lives and to retain the desired qualities of life.
Kelli Deeter is a board-certified family nurse with 12 years of experience in geriatrics, rehabilitation, correction, health of women, mental health and complex chronic care.
#lesson #moment #Healthcare #Blog