Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States

Limited Evidence of Shared Decision Making for Prostate Cancer Screening in Audio-Recorded Primary Care Visits Among Black Men and their Healthcare Providers

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.

Shared decision-making before prostate cancer screening decisions

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.

Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision Making

INTRODUCTION

The 2018 U.S. Preventive Services Task Force recommendations endorsed shared decision making for men aged 55-69 years, encouraging consideration of patient race/ethnicity for prostate-specific antigen screening. This study aimed to assess whether a proxy shared decision-making variable modified the impact of race/ethnicity on the likelihood of prostate-specific antigen screening.

METHODS

A cross-sectional analysis of men aged between 55 and 69 years, who responded to the prostate-specific antigen 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 shared decision making were used to test whether shared decision making modified the impact of race/ethnicity on screening.

RESULTS

Of a weighted sample of 26.8 million men eligible for prostate-specific antigen screening, 25.7% (6.9 million) reported for prostate-specific antigen screening. In adjusted analysis, estimated shared decision making was a significant predictor of prostate-specific antigen screening (AOR=2.65, 95% CI=2.36, 2.98, p<0.001). The interaction between race/ethnicity and estimated shared decision making on the receipt of prostate-specific antigen screening was significant (pint=0.001). Among those who did not report estimated shared decision making, both non-Hispanic Black (OR=0.77, 95% CI=0.61, 0.97, p=0.026) and Hispanic (OR=0.51, 95% CI=0.39, 0.68, p<0.001) men were significantly less likely to undergo prostate-specific antigen screening than non-Hispanic White men. On the contrary, among respondents who reported estimated shared decision making, no race-based differences in prostate-specific antigen screening were found.

CONCLUSIONS

Although much disparities research focuses on race-based differences in prostate-specific antigen screening, research on strategies to mitigate these disparities is needed. Shared decision making might attenuate the impact of race/ethnic disparities on the likelihood of prostate-specific antigen screening.

Cancer Screening: Patient and Population Strategies

Although cancer has been the second leading cause of death for close to 100 years, progress has been made in reducing cancer mortality and morbidity, with the adoption of high-quality screening tests and treatment advances delivered at earlier stages of diagnosis. To achieve the high cancer screening rates demonstrated by some practices, proven effective strategies need to be broadly adopted at both the patient and population levels. Factors affecting cancer screening test completion and approaches to improvement are described both generally and for breast, lung, cervical, colorectal, and prostate cancers. Closing the racial disparity gap is a critical component of reaching cancer screening and prevention goals.

Disparities Associated with Shared Decision-making in Prostate Cancer Screening

BACKGROUND

Prostate cancer screening guidelines recommend shared decision-making (SDM) regarding prostate-specific antigen (PSA) testing. However, it is unclear who undergoes SDM and whether any disparities exist.

OBJECTIVE

To examine sociodemographic differences in participation of SDM and its association with PSA testing in prostate cancer screening.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cross-sectional study was conducted among men aged 45-75 yr undergoing PSA screening, using the 2018 National Health Interview Survey database. The evaluated sociodemographic features included age, race, marital status, sexual orientation, smoking status, working status, financial difficulty, US geographic regions, and cancer history. Questions regarding self-reported PSA testing and whether respondents discussed its advantages and disadvantages with their healthcare provider were analyzed.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Our primary outcome was to evaluate the possible associations between various sociodemographic factors and undergoing PSA screening and SDM. We used multivariable logistic regression analyses to detect potential associations.

RESULTS AND LIMITATIONS

A total of 59596 men were identified, of whom 5605 answered the question regarding PSA testing, with 2288 (40.6%) undergoing PSA testing. Of these men, 39.5% (n = 2226) discussed the advantages and 25.6% (n = 1434) discussed the disadvantages of PSA testing. On a multivariable analysis, older (odds ratio [OR] 1.092; 95% confidence interval [CI] 1.081-1.103, p < 0.001) and married (OR 1.488; 95% CI 1.287-1.720, p < 0.001) men were more likely to undergo PSA testing. Although Black men were more likely to discuss PSA advantages (OR 1.421; 95% CI 1.150-1.756, p = 0.001) and disadvantages (OR 1.554; 95% CI 1.240-1.947, p < 0.001) than White men, this did not correlate with higher rates of PSA screening (OR 1.086; 95% CI 0.865-1.364, p = 0.477). The lack of important clinical data remains a limitation.

CONCLUSIONS

Overall, SDM rates were low. Older and married men had an increased likelihood of SDM and PSA testing. Despite higher rates of SDM, Black men had similar rates of PSA testing to White men.

PATIENT SUMMARY

We evaluated sociodemographic differences in shared decision-making (SDM) in prostate cancer screening using a large national database. We found that SDM had varying results in different sociodemographic groups.

Evaluation of the shared decision-making process scale in cancer screening and medication decisions

OBJECTIVES

Examine reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions.

METHODS

Secondary data analysis from 6174 participants who made decisions about cancer screening (breast, colon or prostate) or medication (menopause, depression, hypertension or high cholesterol). Key measures included the SDM Process scale, decisional conflict, decision regret, and decision quality. Construct validity was examined by testing whether higher SDM Process scores were associated with lower regret, lower decisional conflict and higher decision quality. Meta-analyses summarized data across studies. Some studies assessed the scale's reliability.

RESULTS

Average SDM Process scores ranged from 1.2 to 2.5. There was a moderate-to-large, positive association between scores and lack of decisional conflict (cancer screening: d=0.61, CI(0.38, 0.84), p < .001; medications: d=0.36, CI(0.29, 0.44), p < .001). High scores were associated with lower decision regret (cancer screening: d=-0.24, CI(-0.37, -0.11), p < .001; medications: d=-0.30, CI(-0.40,-0.20), p < .001). There was no relationship with decision quality. Retest reliability was acceptable (ICC>0.7) for seven of eight clinical samples.

CONCLUSIONS

The SDM Process scale demonstrated construct validity and retest reliability in cancer screening and medication decisions.

PRACTICE IMPLICATIONS

The validated SDM Process scale is a short, patient reported metric to evaluate the current state of SDM.

Change in individual physicians' screening mammography completion rates following the updated USPSTF guideline supporting shared decision making: An observational cohort study

OBJECTIVE

To understand changes in physician screening practices in response to the 2009 U.S. Preventive Services Task Force recommendation supporting shared decision making (SDM) for mammography in women aged 40-49 years.

METHODS

We assessed screening completion rates for physicians in the Cleveland Clinic Health System pre-2009 (2006-2008) and post-2009 (2010-2015), and rates for physicians new to the system post-2009. We used mixed effects logistic regression to estimate the odds of a woman receiving screening post-2009. If physicians practiced SDM, we hypothesized their screening rates would change after 2009. To test this, we included each physician's pre-2009 screening rate as a predictor in the model.

RESULTS

Among 125 physicians, the screening rate increased from 40% to 45% from pre-2009 to post-2009. For physicians new to the health system post-2009 the rate was 32%. In the mixed effects model (N = 17,007), the strongest predictor of mammography receipt among patients post-2009 was their physician's pre-2009 screening rate (aOR:3.57 per 10% increase in pre-2009 rate; 95%CI:1.69-7.50).

CONCLUSIONS

Whether a woman received a mammogram post-2009 was highly associated with her physicians' pre-2009 screening rate, suggesting physicians are not individualizing screening decisions via SDM.

PRACTICE IMPLICATIONS

Physicians may need support to effectively practice SDM.

Men's perception of information and descriptions of emotional strain in the diagnostic phase of prostate cancer-a qualitative individual interview study

OBJECTIVE

To explore men`s perception of information and their possible emotional strain in the diagnostic phase of prostate cancer.

DESIGN, SETTING, PATIENTS

A qualitative explorative research design was employed. Data were collected from June to November 2017. The study was set at a urological outpatient clinic at a university hospital in Norway. Semi-structured interviews were conducted with ten men who had been examined for prostate cancer. Interviews were analyzed using Systematic Text Condensation (STC).

RESULTS

The analysis revealed three themes. The theme 'Different needs and perceptions of information' illustrated that information should be personalized. Despite different information needs, insufficient information about prostate cancer may prevent some men from being involved in decisions. The theme, 'A discovery of not being alone', indicated that a sense of affinity occurs when men realize the commonality of prostate cancer. Some men benefited from other men's experiences and knowledge about prostate cancer. The last theme 'Worries about cancer and mortality' showed that the emotional strain was affected by men's knowledge of cancer and the received information. Men expressed conflicting feelings toward prostate cancer that could be difficult to express.

CONCLUSIONS

The findings indicate that men in the diagnostic phase of prostate cancer are not a homogeneous group, but need personalized information. Some men may benefit from other men's experiences and support. Men's emotional strain can affect their communication about prostate cancer, which should be acknowledged. Procedures that identify patients' information needs early on should be an integrated part of the diagnostic phase of prostate cancer.KEY POINTSKnowledge about men's information needs and possible emotional strain in the diagnostic phase of prostate cancer are limited.Men with suspected prostate cancer have different preferences and information needs; however, insufficient information prevents men from participating in decisions.Men experience a sense of affinity with other men affected by prostate cancer, and some men benefit from exchanging experiences.Men consider prostate cancer as a less aggressive type of cancer but may experience emotional strain.

Urban-Rural Differences in Clinical Characteristics of Prostate Cancer at Initial Diagnosis: A Single-Center Observational Study in Anhui Province, China

Background

People residing in rural areas have higher prostate cancer (PCa) mortality to incidence ratio (M/I) and worse prognosis than those in urban areas of China. Clinical characteristics at initial diagnosis are significantly associated with biochemical recurrence, overall survival, and PCa disease-free survival.

Objective

This study aimed at investigating the clinical characteristics at initial diagnosis of urban and rural PCa patients and to establish a logistic regression model for identifying independent predictors for high-grade PCa.

Materials and Methods

Clinical characteristics for PCa patients were collected from the largest prostate biopsy center in Anhui province, China, from December 2015 to March 2019. First, urban-rural disparities in clinical characteristics were evaluated at initial diagnosis. Second, based on pathological findings, we classified all participants into the benign+ low/intermediate-grade PCa or high-grade PCa groups. Univariate and multivariate logistic regression analyses were performed to identify independent factors for predicting high-grade PCa, while a nomogram for predicting high-grade PCa was generated based on all independent factors. The model was evaluated using area under receiver-operating characteristic (ROC) curve as well as calibration curve analyses and compared to a model without the place of residence factor of individuals.

Results

Statistically significant differences were observed between urban and rural PCa patients with regard to tPSA, PSA density (PSAD), and Gleason score (GS) (p < 0.05). Logistic regression analysis revealed that tPSA [OR = 1.060, 95% confidence interval (CI): 1.024, 1.098], PSAD (OR = 14.678, 95%CI: 4.137, 52.071), place of residence of individuals (OR = 5.900, 95%CI: 1.068, 32.601), and prostate imaging reporting and data system version 2 (PI-RADS v2) (OR = 4.360, 95%CI: 1.953, 9.733) were independent predictive factors for high-grade PCa. The area under the curve (AUC) of the nomogram was greater than that of the model without the place of residence of individuals. The calibration curve of the nomogram indicated that the prediction curve was basically fitted to the standard curve, suggesting that the prediction model had a better calibration ability.

Conclusions

Compared to urban PCa patients, rural PCa patients presented elevated tPSA, PSAD levels, and higher pathological grades. The place of residence of the individuals was an independent predictor for high-grade PCa in Anhui Province, China. Therefore, appropriate strategies, such as narrowing urban-rural gaps in access to health care and increasing awareness on the importance of early detection should be implemented to reduce PCa mortality rates.

Prostate Cancer Incidence 5 Years After US Preventive Services Task Force Recommendations Against Screening

BACKGROUND

Previous studies reported that prostate cancer incidence rates in the United States declined for local-stage disease and increased for regional- and distant-stage disease following the US Preventive Services Task Force recommendations against prostate-specific antigen-based screening for men aged 75 years and older in 2008 and for all men in 2012. It is unknown, however, whether these patterns persisted through 2016.

METHODS

Based on the US Cancer Statistics Public Use Research Database, we examined temporal trends in invasive prostate cancer incidence from 2005 to 2016 in men aged 50 years and older stratified by stage (local, regional, and distant), age group (50-74 years and 75 years and older), and race and ethnicity (all races and ethnicities, non-Hispanic Whites, and non-Hispanic Blacks) with joinpoint regression models to estimate annual percent changes. Tests of statistical significance are 2-sided (P < .05).

RESULTS

For all races and ethnicities combined, incidence for local-stage disease declined beginning in 2007 in men aged 50-74 years and 75 years and older, although the decline stabilized during 2013-2016 in men aged 75 years and older. Incidence decreased by 6.4% (95% CI = 4.9%-9% to 7.9%) per year from 2007 to 2016 in men aged 50-74 years and by 10.7% (95% CI = 6.2% to 15.0%) per year from 2007 to 2013 in men aged 75 years and older. In contrast, incidence for regional- and distant-stage disease increased in both age groups during the study period. For example, distant-stage incidence in men aged 75 years and older increased by 5.2% (95% CI = 4.2% to 6.1%) per year from 2010 to 2016.

CONCLUSIONS

Regional- and distant-stage prostate cancer incidence continue to increase in the United States in men aged 50 years and older, and future studies are needed to identify reasons for the rising trends.

Does shared decision making increase prostate screening uptake in countries with a low prevalence of prostate cancer?

BACKGROUND

Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors.

OBJECTIVES

To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening practices among Saudi men.

METHODS

This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed.

RESULTS

In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate examination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing.

CONCLUSION

Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process.

The Importance of Cancer Screening

The burden of cancer in the United States is substantial, providing important opportunity and obligation for primary care clinicians to promote cancer prevention and early detection. Without a system of organized screening to support reminders and follow-up of cancer screening, primary care clinicians face challenges in addressing risk assessment, informed/shared decision making, reminders for screening, and tracking adherence to screening recommendations. Tools exist for collecting information about family history, tracking screening adherence, and reminding patients when they are due for screening, and strategies exist for making cancer prevention and early detection an office policy and delegating roles and responsibilities to office staff.

Effect of a Prostate Cancer Screening Decision Aid for African-American Men in Primary Care Settings

BACKGROUND

African-American men have an elevated risk of developing and dying from prostate cancer. Shared decision-making (SDM) about prostate cancer screening is recommended but does not always occur.

METHODS

We pilot-tested an online decision aid (DA) in primary care settings using a pre/postevaluation design among African-American men ages 45 to 70 years. Men completed surveys before and after using the DA, which had interactive segments (e.g., values clarification) and provided individualized assessment of prostate cancer risk. Primary outcomes included prostate cancer knowledge, confidence in ability to make informed decisions, decisional conflict, and satisfaction with the decision. Immediately after the clinical visit, patients reported the degree to which they were engaged by their provider in SDM.

RESULTS

Among this sample of men (n = 49), use of the DA was associated with increased knowledge about prostate cancer [mean = 55.3% vs. 71.2%; 95% confidence interval (CI), 9.8-22.1; P < 0.001], reduced decisional conflict (mean = 33.4 vs. 23.6; 95% CI, -18.1 to -1.6; P = 0.002) on a scale from 0 to 100, and a decreased preference to be screened (88% vs. 69%; 95% CI, 0.09-0.64; P = 0.01). Most (89%) reported that the DA prepared them well/very well for SDM with their provider. Following the clinical visit with providers, scores on perceived involvement in SDM were 68.1 (SD 29.1) on a 0 to 100 scale.

CONCLUSIONS

The DA improved men's knowledge, reduced decisional conflict, and promoted the perception of being prepared for SDM.

IMPACT

Findings suggest that use of an online DA to improve SDM outcomes warrants further testing in a future trial.

The Movember Prostate Cancer Landscape Analysis: an assessment of unmet research needs

Prostate cancer is a heterogeneous cancer with widely varying levels of morbidity and mortality. Approaches to prostate cancer screening, diagnosis, surveillance, treatment and management differ around the world. To identify the highest priority research needs across the prostate cancer biomedical research domain, Movember conducted a landscape analysis with the aim of maximizing the effect of future research investment through global collaborative efforts and partnerships. A global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy. Men with prostate cancer and thought leaders from a variety of disciplines provided a range of key insights through a range of interviews. Insights were prioritized against predetermined criteria to understand the areas of greatest unmet need. From these efforts, 17 research needs in prostate cancer were agreed on and prioritized, and 3 received the maximum prioritization score by the LAC: first, to establish more sensitive and specific tests to improve disease screening and diagnosis; second, to develop indicators to better stratify low-risk prostate cancer for determining which men should go on active surveillance; and third, to integrate companion diagnostics into randomized clinical trials to enable prediction of treatment response. On the basis of the findings from the landscape analysis, Movember will now have an increased focus on addressing the specific research needs that have been identified, with particular investment in research efforts that reduce disease progression and lead to improved therapies for advanced prostate cancer.

The Movember global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy to identify the highest priority research needs across the prostate cancer biomedical research domain. Findings from the landscape analysis illustrate the research priorities in prostate cancer and will enable Movember to focus on specific needs, with particular investment in research to reduce disease progression and improve therapies for advanced prostate cancer.

Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity

Overall cancer death rates in the United States have declined since 1990. The decline could be accelerated by eliminating socioeconomic and racial disparities in major risk factors and screening utilization. We provide an updated review of the prevalence of modifiable cancer risk factors, screening, and vaccination for U.S. adults, focusing on differences by educational attainment and race/ethnicity. Individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is 6-fold higher among males without a high school (HS) education than female college graduates. Nearly half of women without a college degree are obese versus about one third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with <HS education compared with college graduates. Screening for breast, cervical, and colorectal cancers is also lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks. Enhanced, multilevel efforts are needed to further reduce the prevalence of modifiable risk factors and improve screening and vaccination, particularly among those with lower socioeconomic status and racial/ethnic minorities.

Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid

BACKGROUND

African American men are at a higher risk of developing and dying from prostate cancer compared to white men. The serum prostate-specific antigen (PSA) screening test has a high risk of false-positive results and overdiagnosis; therefore, it is not routinely recommended. Rather, men are encouraged to make individualized decisions with their medical providers, after being fully informed about its potential benefits, limitations, and risks.

OBJECTIVE

This study aimed to describe the development and pilot testing of an interactive Web-based decision aid (DA; Prostate Cancer Screening Preparation [PCSPrep]) for African American men, designed to promote informed decision making for prostate cancer screening.

METHODS

Four focus groups (n=33) were conducted to assess men's reactions to DAs developed in prior studies and gather information to modify the content and format. The pilot test employed a pre-posttest evaluation design. A convenience sample of 41 men aged 45-70 years with no history of prostate cancer was recruited from community settings. Participants completed online surveys before and after using PCSPrep that assessed prostate cancer screening knowledge, decision self-efficacy, decisional conflict, and preparation for decision making.

RESULTS

Use of PCSPrep was associated with a significant increase in prostate cancer knowledge (49% vs 62% correct responses; P<.001), and men also experienced less decisional conflict (24 vs 15 on a scale of 0-100; P=.008). No changes in self-efficacy about decision making or screening preferences were observed. Most men (81%) reported that using PCSPrep prepared them to make informed decisions in partnership with their provider.

CONCLUSIONS

PCSPrep was an acceptable DA that improved men's knowledge, reduced decisional conflict, and promoted the perception of being prepared for shared decision making. Further research is needed to test the DA in a larger randomized trial.

Shared decision making and prostate-specific antigen based prostate cancer screening following the 2018 update of USPSTF screening guideline

BACKGROUND

Previous study reported shared decision making was underused in PSA-based prostate cancer screening. In mid-2018, the US Preventive Service Task Force recommended shared decision making (SDM) before PSA-based prostate cancer screening among men aged 55-69 year while remained against PSA testing in men aged 70 or older. The objective of this study is to examine recent changes in SDM and prostate cancer screening following recent USPSTF recommendations.

METHODS

A retrospective cross-sectional study among men aged 50 years or older were conducted using 2015 and 2018 National Health Interview Survey data (n = 10,926). Outcomes included self-reported PSA testing for prostate cancer screening last year, and if yes, whether respondent ever had a discussion with the healthcare provider about its advantages and disadvantages. Analyses were stratified by respondent's age (50-54 vs. 55-69 vs. 70+).

RESULTS

Routine PSA screening rates remained stable from 34.3% in 2015 to 35.4% in first half of 2018, and 36.0% in second half of 2018 (p trend = 0.57). A similar pattern was found in men ≥70 years (p trend = 0.98). Receipt of SDM increased in men aged ≥50 years from 30.5% in 2015 to 33.6% in first half of 2018, and 36.7% in second half of 2018 (p trend = 0.002). The increase was most prominent in men aged 55 to 69 years (31.6, 36.9, and 40.2% in 2015, first half of 2018 and second half of 2018 respectively; p trend = 0.001).

CONCLUSIONS

Between 2015 and 2018, there was no significant increase in the PSA-based prostate cancer screening. However, a significant increasing trend in SDM was observed, especially in men aged 55-69 years.

Are decision aids leading to shared prostate cancer screening decisions among African-American men?: iDecide

PURPOSE

African-Americans have prostate cancer mortality rates that are double their White counterparts. To reduce prostate cancer disparities, it is suggested that men engage in shared decision making about prostate cancer screening with their healthcare provider after learning about the benefits and harms of these screenings. While researchers have developed decision aids to support African-American's screening decisions, there is some uncertainty whether these aids lead to shared decision making. The goal of the current study was to investigate the efficacy of iDecide, a computerized decision aid, for promoting African-American men's engagement in shared decision making.

METHODS

Six months after their use of iDecide, a prostate cancer screening decision aid, 76 participants were surveyed to determine whether they spoke with a provider about screening, what this conversation entailed, and if shared decision making occurred.

RESULTS

While iDecide is an effective tool for enhancing African-American's intention to engage in shared decision making, there is no evidence this aid increased their likelihood of discussing prostate cancer with a provider or participation in shared decision making.

CONCLUSION

Future research should employ stronger research designs and assess the various contexts that can affect the relationship between decision-aid use and shared decision making among African-Americans.

A blueprint for cancer screening and early detection: Advancing screening's contribution to cancer control

From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.