Prostate screening not always a shared decision

The issue of communication between men and their health-care providers regarding the decision to undergo screening for prostate cancer is emphasized in three studies published in the July/August 2013 issue of Annals of Family Medicine.

Paul K.J. Han, MD, MA, MPH, of Tufts University School of Medicine, Boston, Massachusetts, and colleagues found that most men in the United States report little shared decision making between them and their physicians in terms of choosing or declining to undergo prostate-specific antigen (PSA) screening. In a nationally representative sample of 3,427 men aged 50 years to 74 years who participated in the 2010 National Health Interview Survey, nearly two-thirds (64.3%) reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (categorized as “no shared decision making”). Another 27.8% reported discussing one or two elements only (“partial shared decision making”). Only 8% reported discussing all three elements (“full shared decision making”).

Almost half the men (44.2%) reported undergoing no PSA screening, 27.8% reported undergoing less-than-annual screening, and 25.1% reported undergoing nearly annual screening. Most men (88%) who were not screened reported no shared decision making, compared with 39% of the men who underwent nearly annual screening (Ann Fam Med. 2013;11[4]:306-314).

Rates of shared decision making regarding prostate cancer screening improved when a 20-minute-to-30-minute Web-based educational intervention for physicians was paired with a companion intervention for patients, according to another study in the same issue of Annals of Family Medicine (2013;11[4]:324-334). In an analysis of data from 120 physicians plus 712 male patients who were aged 50 years to 75 years, higher discussion rates regarding prostate cancer screening were seen in the intervention that paired physician education and patient activation (discussion rate of 65%), compared with physician education alone (discussion rate of 41%) and usual education (CDC brochures) on prostate screening (discussion rate of 38%). This research was conducted by Michael S. Wilkes, MD, PhD, of the School of Medicine, University of California, Davis (UC Davis), in Sacramento, California, and colleagues.

The third Annals report (2013;11[4]:315-323) explored how the Web-based educational intervention from the study by Wilkes et al appeared to improve shared decision making, make physicians more neutral in their final recommendations as to whether a patient should undergo PSA testing, and reduce PSA test ordering. Bo Feng, PhD, of UC Davis, and fellow researchers reviewed transcripts from encounters between physicians and trained actors posing as patients. The transcripts revealed that intervention physicians showed more shared-decision-making behaviors, were more likely to mention a no-screening option, and were more likely to encourage patients to consider different screening options and to seek input from others.
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