Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.
Nature reviews. Urology. 2024 Jan 02 [Epub ahead of print]
Kelly R Pekala, Daniela K Shill, Mia Austria, Aisha T Langford, Stacy Loeb, Sigrid V Carlsson
Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA., Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA., Department of Population Health, New York University, New York, NY, USA., Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA. .