Men still want PSA; shared decision making uncommon

Men plan to continue getting PSA tests despite the U.S. Preventive Services Task Force’s recommendation against screening, but just over one-third of men report shared decision making for screening with their physician, according to findings from two recently published studies.

The study examining the impact of the USPSTF recommendation, published in the American Journal of Preventive Medicine (2013; 45:182-9), surveyed 1,089 men 40 to 74 years of age who did not have a history of prostate cancer. The survey, conducted approximately 1 month after the task force initially released its recommendation in October 2011, measured men’s initial response to the recommendation. Men were shown the recommendation and asked to what extent they agreed or disagreed with it and when/if they planned to get a PSA test. Men were also asked whether they were confident that the recommendation was based on the latest research.

The authors found that despite the fact that most participants (61%) agreed with the new PSA testing recommendation and were confident that the recommendation was based on the latest research (69%), only 13% intended to follow it and not get a PSA test. More than half of men (54%) surveyed still plan to get a PSA test in the future, and one-third of participants were undecided.

“Since cancer screening has been promoted as a way to save lives, this recommendation may seem counterintuitive to many people,” said lead author Linda Squiers, PhD, of RTI International, Research Triangle Park, NC.

Men who were in their 50s were significantly more likely than men in their 40s to disagree with the recommendation not to get screened. African-American men, men with higher incomes, those who had had a PSA in the previous 2 years, and men who were somewhat or very worried about getting prostate cancer were also more likely to say they will not follow the new recommendation.

In the second study, published in Annals of Family Medicine (2013; 11:306-14), researchers analyzed data from a nationally representative survey of 3,427 men aged 50 to 74 years, examining the prevalence of three key elements of shared decision making: physician-patient discussion of the advantages, disadvantages, and scientific uncertainty of PSA screening.

Nearly two-thirds (64%) of men reported no past physician-patient discussion of any of the three elements (no shared decision making); 28% reported discussion of one to two elements only (partial shared decision making); and 8% reported discussion of all three elements (full shared decision making). Forty-four percent of participants reported no PSA screening, 28% reported less-than-annual screening, and 25% reported nearly annual screening.

Notably, the absence of shared decision making was more prevalent in men who were not screened-88% of nonscreened men reported no shared decision making compared with 39% of men undergoing nearly annual screening.

These findings, say study authors from Maine Medical Center Research Institute in Portland, provide justification for a broader focus in the current policy debate about PSA screening. While much of this debate has historically focused on PSA screening in the absence of shared decision making and the potential harm of undesired and unnecessary treatment, these findings suggest the more prevalent problem is nonscreening in the absence of shared decision making-the harm of which is the failure to allow individuals to decide for themselves if screening is beneficial.

The authors also found the extent of shared decision making was associated with African-American 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 shared decision making.