title: Prostate cancer screening decision-making in three states: 2013 behavioral risk factor surveillance system analysis.
abstract: Given the discordant prostate cancer screening recommendations in the United States, shared decision-making (SDM) has become increasingly important. The objectives of this study were to determine who made the final decision to obtain prostate-specific antigen (PSA)-based screening and identify factors associated with the screening decision made by both patients and their health care providers.
  
  
  
  Using the 2013 Behavioral Risk Factor Surveillance System data from Delaware, Hawaii, and Massachusetts, we calculated weighted percentages of SDM. Associations between the SDM and sociodemographic, lifestyle, access to care, and PSA testing-related factors were assessed using multivariate logistic regression.
  
  
  
  There were 2,248 men aged 40 years or older who ever had a PSA-based screening in these three states. Only 36% of them made their prostate cancer screening decision jointly with their health care provider. Multivariate analyses showed that men who were married/living together or had a college degree and above were more likely to report having SDM than men who were never married or had less than high school education (P = 0.02 and 0.002). Moreover, men whose most recent PSA test occurred within the past year were more likely to report SDM than men who had the test done more than 2 years ago (P = 0.02).
  
  
  
  The majority of screening decisions were made by the patient or health care provider alone in these three states, not jointly, as recommended. Our study points to the need to promote SDM among patients and their health care providers before PSA testing.
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Hwy, Mail Stop F-76, Atlanta, GA, 30341, Georgia. ffa2@cdc.gov.
authors.forename: Jun
authors.identifier: 0000-0001-6269-4560
authors.initials: J
authors.lastname: Li
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Hwy, Mail Stop F-76, Atlanta, GA, 30341, Georgia.
authors.forename: Ingrid J
authors.initials: IJ
authors.lastname: Hall
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Guixiang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D000066491:Clinical Decision-Making; D003657:Decision Making; D003691:Delaware / Q000453:epidemiology; D055088:Early Detection of Cancer; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D012959:Socioeconomic Factors
chemical_list: D017430:Prostate-Specific Antigen
keywords: Prostate cancer screening; Prostate-specific antigen test; Shared decision-making