Do Men Receive Information Required for Shared Decision Making About PSA Testing? Results from a National Survey.
Most professional organizations, including the American College of Physicians and U.S. Preventive Services Task Force, emphasize that screening for prostate cancer with the prostate-specific antigen (PSA) test should only occur after a detailed discussion between the health-care provider and patient about the known risks and potential benefits of the test. In fact, guidelines strongly advise health-care providers to involve patients, particularly those at elevated risk of prostate cancer, in a "shared decision making" (SDM) process about PSA testing. We analyzed data from the National Cancer Institute's Health Information National Trends Survey 2011-2012-a nationally representative, cross-sectional survey-to examine the extent to which health professionals provided men with information critical to SDM prior to PSA testing, including (1) that patients had a choice about whether or not to undergo PSA testing, (2) that not all doctors recommend PSA testing, and (3) that no one is sure if PSA testing saves lives. Over half (55 %) of men between the ages of 50 and 74 reported ever having had a PSA test. However, only 10 % of men, regardless of screening status, reported receiving all three pieces of information: 55 % reported being informed that they could choose whether or not to undergo testing, 22 % reported being informed that some doctors recommend PSA testing and others do not, and 14 % reported being informed that no one is sure if PSA testing actually saves lives. Black men and men with lower levels of education were less likely to be provided this information. There is a need to improve patient-provider communication about the uncertainties associated with the PSA test. Interventions directed at patients, providers, and practice settings should be considered.
Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA. leyvabryan@gmail.com.
Bryan
B
Leyva
Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Alexander
A
Persoskie
Science of Research and Technology Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Allison
A
Ottenbacher
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Jada G
JG
Hamilton
Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA.
Jennifer D
JD
Allen
Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA.
Sarah C
SC
Kobrin
Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA.
Stephen H
SH
Taplin
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation; D010358:Patient Participation; D010820:Physicians / Q000523:psychology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
PSA testing; Patient-provider communication; Prostate cancer screening; Shared decision making; Uncertainty