The development of a digital GP behaviour change intervention to support GPs in the delivery of evidence based practice around the management of PSA screening and active surveillance in primary care

Every year in the UK more and more men who do not have any prostate cancer (PCa) symptoms are choosing to have a blood test that is used to highlight potential prostate problems (called a PSA test). Diagnosing PCa through a PSA test when the man has no related symptoms does not increase survival but often reduces quality of life and exposes the patient to risky surgical procedures. Evidence suggests a great deal of variability in the way in which GPs use PSA tests and support and advise men who request them. This investigation will aim to develop an internet based behavioural change intervention that will provide GPs with the information and resources they need to better support and counsel men requesting PSA tests.

Secondly, most men diagnosed with slow growing PCa will not receive surgery or radiotherapy but will be managed with active surveillance (AS). AS involves closely monitoring a man’s PCa with blood tests and scans to ensure that the cancer is not growing. Men on AS are usually very anxious and typically experience three times more anxiety than men aged over 65 who haven’t got PCa. This is usually the result of being asked to live and carry on with their life as normal whilst having cancer inside their body. This causes uncertainty about whether removing the cancer surgically could be a safer option. About a quarter of men on AS choose to have surgery because of the anxiety they experience, even though their cancer has not grown or spread. Those who choose to have surgery have a much greater chance of having long term physical side effects such as impotence and incontinence. These will be long term problems that will cause distress for the rest of their lives. AS patient are being increasingly managed by their GPs. Yet GPs have little training and limited resources to help them manage the anxiety and uncertainty commonly experienced by AS patients. The second aim of this investigation is to develop an internet based behavioural change intervention that will provide GPs with the information and resources they need to do better manage and support their AS patients.