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Research ArticleOriginal Research

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

Paul K. J. Han, Sarah Kobrin, Nancy Breen, Djenaba A. Joseph, Jun Li, Dominick L. Frosch and Carrie N. Klabunde
The Annals of Family Medicine July 2013, 11 (4) 306-314; DOI: https://doi.org/10.1370/afm.1539
Paul K. J. Han
1Maine Medical Center Research Institute, Portland, ME; Tufts University School of Medicine, Boston, Massachusetts
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  • For correspondence: hanp@mmc.org
Sarah Kobrin
2Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Nancy Breen
3Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Djenaba A. Joseph
4Centers for Disease Control and Prevention, Atlanta, Georgia
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Jun Li
4Centers for Disease Control and Prevention, Atlanta, Georgia
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Dominick L. Frosch
5Palo Alto Medical Foundation Research Institute, Palo Alto, California
6Department of Medicine, University of California, Los Angeles, California
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Carrie N. Klabunde
3Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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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.

  • prostate-specific antigen
  • mass screening
  • decision making
  • Received for publication October 6, 2012.
  • Revision received January 18, 2013.
  • Accepted for publication February 5, 2013.
  • © 2013 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 11 (4)
The Annals of Family Medicine
Vol. 11, Issue 4
July/August 2013
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National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening
Paul K. J. Han, Sarah Kobrin, Nancy Breen, Djenaba A. Joseph, Jun Li, Dominick L. Frosch, Carrie N. Klabunde
The Annals of Family Medicine Jul 2013, 11 (4) 306-314; DOI: 10.1370/afm.1539

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National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening
Paul K. J. Han, Sarah Kobrin, Nancy Breen, Djenaba A. Joseph, Jun Li, Dominick L. Frosch, Carrie N. Klabunde
The Annals of Family Medicine Jul 2013, 11 (4) 306-314; DOI: 10.1370/afm.1539
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  • Effect of a Prostate Cancer Screening Decision Aid for African-American Men in Primary Care Settings
  • Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis
  • Prostate-Specific Antigen Testing Initiation and Shared Decision-Making: Findings from the 2000 and 2015 National Health Interview Surveys
  • Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States
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Subjects

  • Domains of illness & health:
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  • Person groups:
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  • Methods:
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  • Other research types:
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  • Other topics:
    • Communication / decision making

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  • prostate-specific antigen
  • mass screening
  • decision making

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