A teaching moment – The health care blog

By Kelli Deeter

I was intrigued by Daniel Stone’s play on THCB in May entitled “The diagnosis of Biden cancer as a teaching moment”. In my practice as a practitioner infirmator certified by the Board of Directors, I am frequently questioned on the specific antigen tests of prostate (PSA) by my male patients.

The practice of nursing and medical practice are often vague or grouped. In the state of Colorado, nurses practiced under their own license and can diagnose and treat patients independently. In some contexts where I worked, I frequently found myself correcting patients who call me “doctor”. “I am not a doctor, I am a nurse practitioner”, is repeated by me multiple times a day. In this discussion on PSA tests, I want to share my order decisions or not order PSA tests for individuals, depending on my nursing training.

It is important to refer to Guidelines for PSA tests recommended by the working group on American preventive services (USPSTF), and published by The newspaper of the American Medical Association (JAMA). The latest updates carried out on guidelines took place in 2018. It is essential to remember that these are directives and that doctors, medical assistants and practitioner nurses use these directives in their patient examination. In nursing, a holistic and team approach with patient preferences, history, cultural considerations and desired results are all weighted in decision -making for evaluation, tests, reference and treatment. The guidelines are just that, a guide, not an absolute.

The guidelines indicate that for patients aged 55 to 69: Screening provides a small potential advantage in reducing the risk of prostate cancer death in some men. However, many men will suffer potential screening damage, including false positive results that require additional tests and a possible prostate biopsy; overdiagnosis and over-treatment; And the complications of treatment, such as incontinence and erectile dysfunction … Clinicians should not detect men who do not express any preference for screening. And for patients aged 70 and over: the USPSTF recommends against screening based on PSA for prostate cancer. This does not mean that we, as suppliers, must not test men under 55 or over 70 years old. We must look at each case of patient independently of each other and not to group everyone.

In addition, patients may not know how to “express a preference for screening”. It is imperative that suppliers have time allocated to explore their family history of prostate and other cancers, explain them the advantages and risks of testing, listening and discussing their signs and symptoms, to carry out a digital rectal exam (DRE), if they are appropriate and contained by the patient, considering their diet and their age. Admittedly, if they are symptomatic, and a new medication for their symptoms is prescribed, or if they are symptomatic and a DRE is obtained abnormal, a PSA should be obtained with the patient approval to establish a basic line and a tracking appointment made with repeated laboratories or a reference, if the patient. If there are family history of prostate cancer, an early APS screening test to establish a basic line could be preferable. Again, patient preferences should be taken into account.

People have very different feelings about Western medicine and what they want for themselves and their body. We must realize that it is not because someone has an ever increasing PSA with or without symptoms, he may not accept a DRE or a reference to urology, surgery or oncology. As a supplier, we must obtain a refusal of the recommended care. It is normal not to want tests, follow -up or processing, whatever its age. In the case of Biden, there has been no PSA test since 2014, during its vice-president. The fact that no reason was given is not relevant, in 2014, he was 72 years old. The guidelines do not consist in testing from 70 years old. The level of PSA if it is drawn may not have had its health results or treatments, but this may affect the outcome of its presidency appointment, thus politicizing nursing and medical practices. Point your fingers now in the past does not change anything. I agree with Stone, that it is a teaching moment: defend for yourself as a patient, defend your patient as a supplier, and consider that a large part of his health is a personal choice and that he should be honored and protected.

I agree with The assertion of Peter attracted in his May 24, 2024, a lesson in a timely but tragic lesson on the screening of prostate cancerthat the PSA screening guidelines are obsolete; The last revision took place in 2018. Attia indicates that many men remain healthy and live well after the age of 80, and aggressive cancers if they are captured early and treated, will benefit better from the quality of life and the life of the patient. I would also say that it 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 destitute, homeless, geriatrics, mental patients and incarcerations have greater disparities and have a higher risk of lacking PSA tests. In my work as a practitioner in the correctional system, for people entering prisons and prisons, it is often the first time that they have seen a health care provider. These individuals often have a history of needy, roaming and / or mental illness. In addition, New cancer diagnoses are increasing and for men; 29% of new types of cancer are prostate.

50 years is an important step for most individuals, and they know that they are supposed to obtain screening for colorectal cancer at this age as well as other screening tests. Consolidation of care by capturing a PSA at the same time would establish an early basis base; There is never a guarantee that a patient with problems access to health care will never come back to another meeting, due to finances, transport, fear or other factors. Another consideration to revise the screening guidelines of the APS is to reduce the threshold to PSA levels based on the patient’s age This leads to a reference to urology for imaging and to put a simple language in the guidelines to examine a twice increase of PSA over 6 to 12 weeks, a probable urgent reference to urology. The initiation of an early careful expectation with the PSA screening has the potential to save more lives and maintain the desired qualities of life.

Kelli Deeter is a certified family nurse with 12 years of experience in geriatrics, rehabilitation, correction, women’s health, mental health and complex chronic care.