In the Journals

Shared decision-making rates in PSA testing not significantly increasing

Otis Brawley
Otis Brawley

The number of men receiving one or more components of shared decision making as part of the prostate cancer screening process increased less than 4% between 2010 and 2015, according to new study findings published in Annals of Family Medicine.

Otis Brawley, MD, MACP, FASCO, FACE, chief medical and scientific officer at the American Cancer Society, and one of the study’s co-authors, told Healio Family Medicine that these findings are a shame, but not surprising.

In April 2017, the U.S. Preventive Services Task Force issued a recommendation indicating the decision about whether or not men aged 55 to 69 years should be screened for PSA was an individual one. The task force had previously recommended against PSA screening.

In the new study, researchers retrospectively reviewed National Health Interview Survey data from 9,598 men 50 years of age and older on the components of shared decision making: the patient knowing about the advantages only, both advantages and disadvantages, and full shared decision-making (advantages, disadvantages, and uncertainties).

Fedewa and colleagues found that of the men who underwent PSA testing in the past year, 58.5% received one or more shared decision-making elements in 2010. That number increased to 62.6% (adjusted prevalence ratio = 1.04; 95% CI, 0.98-1.11) in 2015. In the same 5-year period, those who received only information about the advantages of PSA testing significantly declined (adjusted prevalence ratio = 0.82; 95% CI, 0.71-0.96). Full shared decision-making prevalence significantly increased (adjusted prevalence ratio = 1.51; 95% CI, 1.28-1.79). In both 2010 and 2015, just 10% of the men who had not previously undergone PSA testing said they received one or more element of shared decision making.

“The research is important as it notes a large number of men are not having the discussion,” Brawley told Healio Family Medicine. “We went into the work with the assumption that a large proportion of men do not get to have a discussion with their doctor about prostate cancer screening.”

He acknowledged office visits are finite and suggested that perhaps medical office procedures be revisited.

“I understand that many physician visits are short and there is just not enough time for this discussion and so many other conversations. I believe we need to rethink how we give care to allow for more time for discussion,” he said.

Brawley also addressed primary care physicians and family practitioners who may not want to change long-standing practices.

“I do believe that ethical principles call for an informed patient who can consent to screening or decide not to get screening. It is true that the information conveyed has changed over time,” he added. “The evidence of benefit has gotten a little more solid. It has also been quantified that the number who benefit are small. Virtually every recent screening study documents the evidence for overdiagnosis and potential for overtreatment.” - by Janel Miller

Disclosure: The authors report no relevant financial disclosures.

Otis Brawley
Otis Brawley

The number of men receiving one or more components of shared decision making as part of the prostate cancer screening process increased less than 4% between 2010 and 2015, according to new study findings published in Annals of Family Medicine.

Otis Brawley, MD, MACP, FASCO, FACE, chief medical and scientific officer at the American Cancer Society, and one of the study’s co-authors, told Healio Family Medicine that these findings are a shame, but not surprising.

In April 2017, the U.S. Preventive Services Task Force issued a recommendation indicating the decision about whether or not men aged 55 to 69 years should be screened for PSA was an individual one. The task force had previously recommended against PSA screening.

In the new study, researchers retrospectively reviewed National Health Interview Survey data from 9,598 men 50 years of age and older on the components of shared decision making: the patient knowing about the advantages only, both advantages and disadvantages, and full shared decision-making (advantages, disadvantages, and uncertainties).

Fedewa and colleagues found that of the men who underwent PSA testing in the past year, 58.5% received one or more shared decision-making elements in 2010. That number increased to 62.6% (adjusted prevalence ratio = 1.04; 95% CI, 0.98-1.11) in 2015. In the same 5-year period, those who received only information about the advantages of PSA testing significantly declined (adjusted prevalence ratio = 0.82; 95% CI, 0.71-0.96). Full shared decision-making prevalence significantly increased (adjusted prevalence ratio = 1.51; 95% CI, 1.28-1.79). In both 2010 and 2015, just 10% of the men who had not previously undergone PSA testing said they received one or more element of shared decision making.

“The research is important as it notes a large number of men are not having the discussion,” Brawley told Healio Family Medicine. “We went into the work with the assumption that a large proportion of men do not get to have a discussion with their doctor about prostate cancer screening.”

He acknowledged office visits are finite and suggested that perhaps medical office procedures be revisited.

“I understand that many physician visits are short and there is just not enough time for this discussion and so many other conversations. I believe we need to rethink how we give care to allow for more time for discussion,” he said.

Brawley also addressed primary care physicians and family practitioners who may not want to change long-standing practices.

“I do believe that ethical principles call for an informed patient who can consent to screening or decide not to get screening. It is true that the information conveyed has changed over time,” he added. “The evidence of benefit has gotten a little more solid. It has also been quantified that the number who benefit are small. Virtually every recent screening study documents the evidence for overdiagnosis and potential for overtreatment.” - by Janel Miller

Disclosure: The authors report no relevant financial disclosures.