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

The Article in Brief

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

Paul K. J Han , and colleagues

Background The prostate-specific antigen (PSA) test, which screens for prostate cancer, has limited accuracy, and there is conflicting evidence for its effectiveness in reducing mortality. Because of the nature of prostate cancer, PSA screening can lead to overdiagnosis and unnecessary evaluation and treatment. Professional organizations therefore recommend that clinicians inform patients about the pros, cons, and uncertainties of PSA screening, and that screening decisions be based on patient preferences. This study examines the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making.

What This Study Found Most US men report little shared decision making in PSA screening, and the absence of shared decision making is more prevalent in men who are not screened. Nearly two-thirds of men report no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty of PSA screening (no shared decision making); 28 percent report discussion of 1 to 2 elements (partial shared decision making); and 8 percent report discussion of 3 elements (full shared decision making). Forty-four percent of participants report no PSA screening, 28 percent report less than annual screening, and 25 percent report nearly annual screening. The extent of shared decision making is associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity is associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial shared decision making.

Implications

• These findings, the authors assert, justify a broader policy debate about PSA screening. Much of the debate has focused on the absence of shared decision making in PSA screening and the potential harm of undesired and unnecessary treatment. This study suggests the more prevalent problem is the absence of shared decision making in nonscreening--the harm of which is the failure to allow individuals to decide for themselves whether screening is beneficial.