Factors associated with appropriate and low-value PSA testing

Oswald, Nathaniel W.; Lin, Tengda; Haaland, Benjamin; Flynn, Michael; Kawamoto, Kensaku; Cooney, Kathleen A.; Lowrance, William T.; Hanson, Heidi A.; O’Neil, Brock

doi:10.1016/j.canep.2020.101724

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…8,32 Furthermore, a prior study using these data found that roughly one-half of patients fall on either side. 35 Descriptive statistics of patient, clinician, and appointment characteristics were stratified by the appropriateness of ordering a PSA test within each appointment. Each appointment was treated independently because of the structure of the data set, thus we did not assign multiple appointments to a single patient.…”

Section: Discussionmentioning

confidence: 99%

“…This threshold was chosen because it is the age at which current American Urological Association and US Preventive Services Task Force guidelines begin supporting the use of PSA screening for PCa in the context of shared decision making 8,32 . Furthermore, a prior study using these data found that roughly one‐half of patients fall on either side 35 …”

Section: Methodsmentioning

confidence: 99%

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Decision fatigue in low‐value prostate cancer screening

Hunt

Ambrose

Haaland

et al. 2021

Cancer

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Background Low‐value prostate‐specific antigen (PSA) testing is common yet contributes substantial waste and downstream patient harm. Decision fatigue may represent an actionable target to reduce low‐value urologic care. The objective of this study was to determine whether low‐value PSA testing patterns by outpatient clinicians are consistent with decision fatigue. Methods Outpatient appointments for adult men without prostate cancer were identified at a large academic health system from 2011 through 2018. The authors assessed the association of appointment time with the likelihood of PSA testing, stratified by patient age and appropriateness of testing based on clinical guidelines. Appointments included those scheduled between 8:00 am and 4:59 pm, with noon omitted. Urologists were examined separately from other clinicians. Results In 1,581,826 outpatient appointments identified, the median patient age was 54 years (interquartile range, 37‐66 years), 1,256,152 participants (79.4%) were White, and 133,693 (8.5%) had family history of prostate cancer. PSA testing would have been appropriate in 36.8% of appointments. Clinicians ordered testing in 3.6% of appropriate appointments and in 1.8% of low‐value appointments. Appropriate testing was most likely at 8:00 am (reference group). PSA testing declined through 11:00 am (odds ratio [OR], 0.57; 95% CI, 0.50‐0.64) and remained depressed through 4:00 pm (P < .001). Low‐value testing was overall less likely (P < .001) and followed a similar trend, declining steadily from 8:00 am (OR, 0.48; 95% CI, 0.42‐0.56) through 4:00 pm (P < .001; OR, 0.23; 95% CI, 0.18‐0.30). Testing patterns in urologists were noticeably different. Conclusions Among most clinicians, outpatient PSA testing behaviors appear to be consistent with decision fatigue. These findings establish decision fatigue as a promising, actionable target for reducing wasteful and low‐value practices in routine urologic care. Lay Summary Decision fatigue causes poorer choices to be made with repetitive decision making. This study used medical records to investigate whether decision fatigue influenced clinicians' likelihood of ordering a low‐value screening test (prostate‐specific antigen [PSA]) for prostate cancer. In more than 1.5 million outpatient appointments by adult men without prostate cancer, the chances of both appropriate and low‐value PSA testing declined as the clinic day progressed, with a larger decline for appropriate testing. Testing patterns in urologists were different from those reported by other clinicians. The authors conclude that outpatient PSA testing behaviors appear to be consistent with decision fatigue among most clinicians, and interventions may reduce wasteful testing and downstream patient harms.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Decision fatigue in low‐value prostate cancer screening

Hunt

Ambrose

Haaland

et al. 2021

Cancer

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“…7 Most prior research on low-value PC screening has been conducted among commercially insured men, veterans in the Veterans Administration health care system, and single health care systems. [8][9][10][11] These analyses, however, are not nationally representative of clinic visits or may not include men who are uninsured or who are covered through Medicaid or Medicare.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey

et al. 2023

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Introduction: There has been an increasing focus on improving value in health care and deimplementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. The objectives of this study are to (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics associated with low-value PC screening in the United States.Methods: This was a secondary analysis of the National Ambulatory Medicare Care Survey datasets from 2013 to 2016 and 2018. Andersen's Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze data.Results: There were 6.71 low-value prostate-specific antigens (PSAs) per 100 visits and 1.65 lowvalue digital rectal exams (DREs) per 100 visits. For each additional service ordered by primary care providers, the odds of ordering a low-value PSA increased by 49%, and the odds of performing a lowvalue DRE increased by 37%.Conclusions: The use of low-value PSAs and DREs was sizable during the observed time period. Organizations who want to reduce low-value PSAs and DREs may want to focus interventions on providers who order a high number of tests.

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Increasing the value of PSA through improved implementation

Lange

O’Neil

2023

Urologic Oncology: Seminars and Original Investigations

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Factors associated with appropriate and low-value PSA testing

Cited by 4 publications

References 23 publications

Decision fatigue in low‐value prostate cancer screening

Decision fatigue in low‐value prostate cancer screening

The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey

Increasing the value of PSA through improved implementation

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