The 2018 United States Preventive Services Task Force recommendations endorsed shared decision-making (SDM) for men aged 55-69, encouraging consideration of patient race/ethnicity for prostate-specific antigen (PSA) screening. This study aimed to assess whether a proxy SDM variable modified the effect of race/ethnicity on the likelihood of PSA screening.
A cross-sectional analysis of men between 55 and 69 years, who responded to the PSA screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated SDM were used to test whether SDM modified the effect of race/ethnicity on screening.
Out of a weighted sample of 26.8 million men eligible for PSA screening, 25.7% (6.9 million) reported PSA screening. In adjusted analysis, estimated SDM was a significant predictor of PSA screening (aOR:2.65, 95%CIs: 2.36-2.98, p<0.001). The interaction between race/ethnicity and estimated SDM on the receipt of PSA screening was significant (pint=0.001). Among those who did not report estimated SDM, both non-Hispanic Black (OR: 0.77, 95%CIs: 0.61-0.97, p=0.026) and Hispanic (OR: 0.51, 95%CIs: 0.39-0.68, p<0.001) men were significantly less likely to undergo PSA screening than non-Hispanic White men. On the contrary, among respondents who reported estimated SDM, no race-based differences in PSA screening were found.
While much disparities research focuses on race-based differences in PSA screening, research on strategies to mitigate these disparities is needed. SDM might attenuate the effect of race/ethnic disparities on the likelihood of PSA screening.
American journal of preventive medicine. 2023 Aug 09 [Epub ahead of print]
Nicola Frego, Edoardo Beatrici, Muhieddine Labban, Benjamin V Stone, Dejan K Filipas, Mara Koelker, Giovanni Lughezzani, Nicolò M Buffi, Nora Y Osman, Stuart R Lipsitz, Jesse D Sammon, Adam S Kibel, Quoc-Dien Trinh, Alexander P Cole
Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy., Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Division of Urology, Maine Medical Center, Portland, Maine; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine.