Men's experiences of physical exams and cancer screening tests: a qualitative study.

BACKGROUND: American men have lower overall rates of cancer screening than women. This study was designed to elicit men's health care experiences and knowledge of testicular, prostate, and colorectal cancer (CRC) screening. METHODS: Fifty-three men participated in eight physician-led semistructured focus groups in Rhode Island and New Hampshire. Four groups (ages 18-35; N = 20) discussed testicular cancer screening. Four groups of older men (ages 40-79; N = 33) discussed prostate and colorectal cancer screening. RESULTS: Men in this study prefer physicians who establish interpersonal relationships with male patients. Lack of explanations during physical exams resulted in negative experiences. Men were eager to learn more about their health, but commonly complained that they received neither appropriate cancer screening nor sufficient explanations from their physicians. When PSA screening was offered, discussion was often inadequate. Although men expressed interest in participating in the PSA decision, sole responsibility for this complex decision was seen as undesirable. These men desired more discussion and better sources of health information during medical encounters. CONCLUSIONS: Clinician attention to communication, relationship building, patient education, and consideration for patient privacy and modesty are important for the care of male patients especially with sensitive exams and topics important to men's cancer screening.

Teaching the testicular exam: a model curriculum from "A" to "Zack".

BACKGROUND AND OBJECTIVES: The testicular exam was not explicitly taught at our medical schools before 2002. In this article, we explore different phases of curriculum development, implementation, and evaluation of a method for teaching the testicular exam. METHODS: Medical students participated in surveys and focus groups, and male patients participated in focus groups. From the results of the focus groups, we developed a comprehensive testicular exam module that includes (1) a PowerPoint lecture, (2) a video, (3) reading materials, and (4) an artificial male model ("Zack"). These materials were then incorporated into family medicine clerkships. Students and faculty have evaluated the project. RESULTS: Initially, students expressed discomfort discussing sexual issues with patients, especially those of the opposite gender, and knew little about testicular cancer. Male patients had limited knowledge of the testicular self-exam and felt that their physical exam training had not been ideal. Faculty and students agreed that a lecture on the testicular exam and practice with Zack were useful in improving their exam skills, while the video and readings were less so. CONCLUSIONS: To address curricular deficits, a self-contained module on the testicular exam has been successfully incorporated into family medicine clerkships at two different medical schools. This module is easily adaptable to other settings and institutions.

A qualitative study of communication skills for male cancer screening discussions.

BACKGROUND: Cancer screening guidelines acknowledge the need for physician-patient discussions on appropriate tests. This study examined expert clinician communication practices associated with prostate and colorectal cancer screening and testicular cancer early detection for male patients. METHODS: Recorded observation and qualitative analysis of transcripts from 38 standardized patient interactions. RESULTS: Most effective communication practices were elicited from the data and incorporated into a model for male cancer screening discussions. CONCLUSIONS: Qualitative analysis of expert clinician interactions can identify best communication practices leading to the development of a communication model used in medical student teaching.