CONTEXT: Routine cancer screening with prostate-specific antigen (PSA) is 
controversial, and practice guidelines recommend that men be counseled about its 
risks and benefits.
OBJECTIVE: To evaluate the process of decision making as men react to and use 
information after PSA counseling.
DESIGN: Written surveys and semistructured qualitative interviews before and 
after a neutral PSA counseling intervention.
PARTICIPANTS: Men 40 to 65 years of age in southeastern Michigan were recruited 
until thematic saturation--that is, the point at which no new themes emerged in 
interviews (n = 40).
RESULTS: In a paper survey, 37 of 40 participants (93%) said that they 
interpreted the counseled information as unfavorable toward PSA. However, 30 
participants (75%) said after the intervention that they intended to be tested 
in the future, including 29 of 30 men (97%) with prior PSA testing. In the 
interview, many participants cited underlying beliefs as a reason to dismiss the 
counseled information. Qualitative analysis found the seven most common beliefs 
cited were fear of cancer, relevance of salient anecdotes and analogies, 
distrust of statistics, enthusiasm for "prevention," protection from "bad luck," 
faith in science, and valuing PSA as knowledge for its own sake. Although some 
beliefs could be interpreted as judgment errors, most were credible on a 
personal level.
CONCLUSIONS: Most men who underwent PSA counseling cited underlying beliefs 
rather than the content of counseled information as the basis for their 
decisions regarding future PSA screening. If widespread, such beliefs may render 
clinician counseling and decision support methods less effective. Eliciting 
patient beliefs prior to counseling may improve the shared decision-making 
process.