Prostate-Specific Antigen Testing Initiation and Shared Decision-Making: Findings from the 2000 and 2015 National...

Area of Science:

• Urology
• Public Health
• Health Services Research

Background:

• Prostate cancer screening using prostate-specific antigen (PSA) tests is recommended against by many guidelines.
• Despite recommendations, PSA testing remains prevalent, with about one-fourth of men aged 40 years and older receiving tests in 2015.
• Understanding the initiation of PSA testing and shared decision-making is crucial for patient-centered care.

Purpose of the Study:

• To determine the percentage of men who received physician-initiated PSA testing (PIPT).
• To identify factors associated with PIPT versus patient-initiated testing.
• To assess the prevalence of shared decision-making in PSA test initiation.

Main Methods:

• Analysis of the 2000 and 2015 National Health Interview Survey data.
• Calculation of age-standardized prevalence of PIPT for both years.
• Logistic regression used to calculate adjusted prevalence ratios for PIPT in 2015.

Main Results:

• The age-standardized prevalence of PIPT increased significantly from 72.3% in 2000 to 84.9% in 2015.
• In 2015, physicians initiated nearly 90% of PSA screenings for men aged 70 years and older.
• PIPT was associated with having multiple comorbid conditions and higher healthcare utilization.

Conclusions:

• Physicians are the primary initiators of PSA testing for most men, particularly older men.
• Less than one-third of men reported engaging in shared decision-making regarding PSA test advantages and disadvantages.
• There is a significant need to improve shared decision-making processes in clinical practice for PSA testing.