Association of GPs' risk attitudes, level of empathy, and burnout status with PSA testing in primary care

Br J Gen Pract. 2015 Dec;65(641):e845-51. doi: 10.3399/bjgp15X687649. Epub 2015 Nov 5.


Background: Rates of prostate specific antigen (PSA) test ordering vary among GPs.

Aim: To examine whether GPs' risk attitude, level of empathy, and burnout status are associated with PSA testing.

Design and setting: Register and questionnaire study including 129 solo GPs (active in the Central Denmark Region) and 76 672 of their adult male patients with no history of or current prostate cancer diagnosis.

Method: PSA tests from 2012 were retrieved from a register and classified as incident (that is, the first PSA test within 24 months), repeated normal, or repeated raised tests. This was merged with information on GPs' risk attitudes, empathy, and burnout status from a 2012 survey.

Results: Patients registered with a GP with a high score on anxiety caused by uncertainty (odds ratio [OR] 1.03, 95% confidence interval [CI] = 1.00 to 1.06, P = 0.025) or concern about bad outcomes (OR 1.04; 95% CI = 1.00 to 1.08, P = 0.034) were more likely to have an incident PSA test, whereas those registered with a GP with increased tolerance for ambiguity were less likely (OR 0.98, 95% CI = 0.96 to 1.00, P = 0.025). Patients registered with a GP reporting high tolerance for ambiguity (OR 0.96, 95% CI = 0.94 to 0.99, P = 0.009) or high propensity to risk-taking (OR 0.97, 95% CI = 0.93 to 1.00, P = 0.047) were less likely to have a repeated normal PSA test.

Conclusion: Various aspects of GPs' risk-taking attitudes were associated with patients' probability of having an incident and a repeated normal PSA test. The probability of having a repeated raised PSA test was not influenced by any of the psychological factors. Burnout and empathy were not associated with PSA testing.

Keywords: medical errors; patient safety; primary health care; prostatic neoplasms; psychological; quality of health care; stress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Burnout, Professional / epidemiology*
  • Denmark / epidemiology
  • Early Detection of Cancer / standards
  • Early Detection of Cancer / statistics & numerical data*
  • Empathy
  • Humans
  • Male
  • Mass Screening
  • Odds Ratio
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care*
  • Prospective Studies
  • Prostate-Specific Antigen / analysis*
  • Prostatic Neoplasms / diagnosis*
  • Risk-Taking


  • Prostate-Specific Antigen