Prostate-specific antigen (PSA)-based prostate cancer screening is a preference-sensitive decision for which experts recommend a shared decision making (SDM) approach. This study aimed to examine PSA screening SDM in primary care. Methods included qualitative analysis of audio-recorded patient-provider interactions supplemented by quantitative description. Participants included 5 clinic providers and 13 patients who were: (1) 40-69 years old, (2) Black, (3) male, and (4) attending clinic for routine primary care. Main measures were SDM element themes and "observing patient involvement in decision making" (OPTION) scoring. Some discussions addressed advantages, disadvantages, and/or scientific uncertainty of screening, however, few patients received all SDM elements. Nearly all providers recommended screening, however, only 3 patients were directly asked about screening preferences. Few patients were asked about prostate cancer knowledge (2), urological symptoms (3), or family history (6). Most providers discussed disadvantages (80%) and advantages (80%) of PSA screening. Average OPTION score was 25/100 (range 0-67) per provider. Our study found limited SDM during PSA screening consultations. The counseling that did take place utilized components of SDM but inconsistently and incompletely. We must improve SDM for PSA screening for diverse patient populations to promote health equity. This study highlights the need to improve SDM for PSA screening.
Journal of immigrant and minority health. 2024 Jun 01 [Epub ahead of print]
Elizabeth R Stevens, Jerry Thomas, Natalia Martinez-Lopez, Angela Fagerlin, Shannon Ciprut, Michele Shedlin, Heather T Gold, Huilin Li, J Kelly Davis, Ada Campagna, Sandeep Bhat, Rueben Warren, Peter Ubel, Joseph E Ravenell, Danil V Makarov
Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA. ., Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA., Department of Population Health Sciences, University of Utah Spencer Eccles School of Medicine, Salt Lake City, UT, USA., NYU College of Nursing, New York, NY, USA., The Fuqua School of Business, Duke University, Durham, NC, USA., Sunset Park Health Council, Brooklyn, NY, USA., National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, USA.