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PURPOSE: Screening for prostate cancer with the prostate-specific antigen (PSA) remains highly controversial. We sought to discern which patient factors predict interest in the PSA and how informed consent impacts these predictors. PATIENTS AND METHODS: In a randomized trial that found that informed consent decreases patient interest in PSA screening, potential predictors of interest were analyzed separately in the uninformed (n = 102) and informed (n = 103) cohorts to examine the effects of the informational intervention. RESULTS: Univariate predictors of PSA screening interest (P [is less than] 0.05) among uninformed patients included perceived efficacy of screening, perceived seriousness of an abnormal PSA, and willingness to accept treatment risks. Among patients who had been informed about PSA screening, univariate predictors included family history of prostate cancer, perceived susceptibility to prostate cancer, age (inverse association), and perceived efficacy, although informed patients rated PSA efficacy significantly lower than uninformed patients (P [is less than] 0.001). In multivariate logistic regression modeling for the uninformed cohort, perceived screening efficacy (P [is less than] 0.001), perceived seriousness (P [is less than] 0.05), and willingness to accept treatment risks (P [is less than] 0.05) together were significant predictors of PSA screening interest. Among informed patients, perceived efficacy (P [is less than] 0.001), perceived susceptibility (P = 0.01), and younger age (P = 0.01) together predicted interest in screening. CONCLUSIONS: In contrast to uninformed patients, patients given information about PSA screening and prostate cancer are more likely to be interested in screening if they have a family history of prostate cancer, are younger, or otherwise consider themselves susceptible to developing prostate cancer. Uninformed patients are more likely to base their screening interest on the perceived seriousness of prostate cancer and on their willingness to accept treatment risks. Am J Med. 1997;103:308-314. [C] 1997 by Excerpta Medica, Inc.

Background and Objective: The two-question drinking test ('Have you ever had a drinking problem?' and When was your last drink?') is frequently cited as an accurate method of screening for alcoholism, yet its performance has never been validated. This study evaluated its utility among patients in two primary care settings. Patients and Methods: The two-question drinking test was compared to the Michigan Alcohol Screening Test (MAST) as the standard criterion for the diagnosis of alcoholism. The subjects were 334 nonpregnant English-speaking patients over the age of 18 seen in two university outpatient teaching clinics. Results: The overall prevalence of alcoholism based on a MAST score [greater than equal to]5 was 18%. The sensitivity of the two-question test was 53% and its specificity 93%. The question When was your last drink?' added little to the question Have you ever had a drinking problem?' The latter question alone had a sensitivity of 50% and a specificity of 97%. Conclusions: The two-question test is not sensitive enough to be used to screen for alcohol abuse among outpatients. However, because of the low false positive rate, a positive response to the question 'Have you ever had a drinking problem?' may help identify alcoholic patients.

Background: Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR. Methods: The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics. Results: Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older. Conclusions: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of in-hospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival. (Arch Intern Med. 1994;154:2426-2432)