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

Fedewa, Stacey A.; Gansler, Ted; Smith, Robert A.; Sauer, Ann Goding; Wender, Richard C.; Brawley, Otis W.; Jemal, Ahmedin

doi:10.1370/afm.2200

Cited by 22 publications

(22 citation statements)

References 30 publications

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“…The recent decline in PSA testing has been predominately attributed to the change in the USPSTF prostate cancer screening recommendation in 2012 from a recommendation for shared decision making to a recommendation against screening, which was then returned to shared decision making in the 2018 update . Data on shared decision making indicate that 63% of men aged 50 years and older reported receiving at least 1 element of shared decision making in 2015 . During the same year, only 17% of men with a recent PSA test reported participating in full shared decision making, and receipt was even lower among men without a high school diploma compared with college graduates …”

Section: Prostate Cancermentioning

confidence: 99%

“…Furthermore, many clinicians have not overcome barriers to routinely using shared decision making in presenting options for screening to men. As a result, it is likely that some clinicians simply recommend screening, recommend against screening, or do not discuss screening at all . One of the most important challenges to improving the quality of prostate cancer screening is helping primary care clinicians universally offer screening and to do so with a high‐quality, shared decision‐making process.…”

Section: Prostate Cancermentioning

confidence: 99%

“…145 Data on shared decision making indicate that 63% of men aged 50 years and older reported receiving at least 1 element of shared decision making in 2015. 149 During the same year, only 17% of men with a recent PSA test reported participating in full shared decision making, and receipt was even lower among men without a high school diploma compared with college graduates. 150…”

Section: Trends In Prostate Cancer Screening and Shared Decision Makingmentioning

confidence: 99%

“…As a result, it is likely that some clinicians simply recommend screening, recommend against screening, or do not discuss screening at all. 149 One of the most important challenges to improving the quality of prostate cancer screening is helping primary care clinicians universally offer screening and to do so with a high-quality, shared decision-making process. The ACS has produced decision aids to help clinicians offer screening to men.…”

Section: Challenges and Opportunities To Improve The Effectiveness Ofmentioning

confidence: 99%

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A blueprint for cancer screening and early detection: Advancing screening’s contribution to cancer control

Wender

Brawley

Fedewa

et al. 2018

CA A Cancer J Clinicians

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From the mid‐20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk‐based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state‐of‐the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.

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Section: Prostate Cancermentioning

confidence: 99%

Section: Prostate Cancermentioning

confidence: 99%

Section: Trends In Prostate Cancer Screening and Shared Decision Makingmentioning

confidence: 99%

Section: Challenges and Opportunities To Improve The Effectiveness Ofmentioning

confidence: 99%

See 2 more Smart Citations

A blueprint for cancer screening and early detection: Advancing screening’s contribution to cancer control

Wender

Brawley

Fedewa

et al. 2018

CA A Cancer J Clinicians

Self Cite

View full text Add to dashboard Cite

show abstract

“…They find that during the past 5 years, there has been a shift away from patients being told only about the advantages of PSA testing toward fuller shared decision discussions, despite no overall increase in rates of shared decision making. 8 Profetto et al examine a different test for screening for prostate cancer-digital rectal examination. In a systematic review and meta-analysis, they discover that rectal exam has low sensitivity, specificity, and positive and negative predictive value for finding biopsy-proven prostate cancer.…”

Section: 4mentioning

confidence: 99%

In This Issue: Refining Care and its Frameworks

Stange¹

2018

Ann Fam Med

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Prostate Cancer Screening—A New Recommendation for Meaningful Physician-Patient Conversations

Misra‐Hebert

Kattan

2018

JAMA Oncol

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The US Preventive Services Task Force (USPSTF) recommendation statement for screening for prostate cancer, 1 supported by the evidence report, 2,3 has been updated to a grade C recommendation, from the grade D recommendation of the 2012 statement, 4 regarding prostate-specific antigen (PSA)-based screening. In 2012, the USPSTF recommended against PSA-based screening for prostate cancer, but now the Task Force concludes that "for men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one." 1 (For men 70 years or older, the Task Force maintains its D recommendation for PSA-based prostate cancer screening.) After the 2012 USPSTF recommendation and prior to this updated statement, other groups had responded to the complexity of the prostate cancer screening decision with additional recommendations. For example, in 2013, the American Urologic Association recommended a shared decision-making approach to prostate cancer screening for men aged 55 to 69 years, 5 and the American College of Physicians also recommended a screening approach incorporating patient preferences for men aged 50 to 69 years, 6 with both organizations recommending against screening in men 70 years or older or with life expectancy less than 10 to 15 years. 5,6 However, even with these recommendations, shared decision making for prostate cancer screening overall has not significantly increased. 7 How can individualized and shared decision making for prostate cancer screening be successfully implemented? It is not clear that patient preferences for the screening decision can be quantified at the population level or that a measure such as quality-adjusted life-years can be appropriately generalizable for this choice. 8 Cowen et al 9 have previously cautioned against applying group-level utilities to the treatment decision for localized prostate cancer, and this may similarly apply to the screening decision. Seemingly, the only route to implementing this updated USPSTF recommendation is through participating in meaningful physician-patient conversations to understand individual preferences.A large proportion of discussions regarding prostate cancer screening will occur with primary care physicians, but the feasibility of incorporating this additional task into routine primary care practice has been questioned. 10 However, it is clear that these types of conversations are a necessity to deliver optimal patient care even while there does not appear to be enough time or any specific incentives tied to engaging in these discussions. That several guidelines now recommend a shared decision-making approach for prostate cancer screening is a strong indication that, for this decision, the available data do not allow the physician to

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

Cited by 22 publications

References 30 publications

A blueprint for cancer screening and early detection: Advancing screening’s contribution to cancer control

A blueprint for cancer screening and early detection: Advancing screening’s contribution to cancer control

In This Issue: Refining Care and its Frameworks

Prostate Cancer Screening—A New Recommendation for Meaningful Physician-Patient Conversations

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