National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening

Abstract

PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making.METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics.RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making.CONCLUSIONS Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.

Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States

“…We defined shared decision making using a framework similar to that employed by Han and collegues, 8 which includes necessary components of shared decision making according to ACS and AUA recommendations. 3,4 These components include informing patients about the advantages and disadvantages of PSA testing, as well as uncertainties regarding the test.…”

“…2 Previous studies have shown that most men undergoing PSA testing reported either no discussion or only heard about the benefits of the test. 8,9 Other studies have shown variability and inadequacy of shared decision making. [9][10][11][12][13] It is not known, however, whether the use of shared decision making has changed in the wake of the shifting PSA-screening recommendations and practices at the national level.…”

Prostate Cancer Screening

“…37 US men describe not having engaged in shared decision making with their clinician when making decisions about Pca screening. 38 The decision to undergo Pca screening must involve an explicit discussion between patient and clinician of the possible benefits weighed against expected harms.…”

Shared Decision Making, Contextualized

“…7 They discovered that 88% of unscreened men and 39% of men undergoing annual or near-annual screening received no elements of shared decision making.…”