PSAzing up patient care: a quality improvement project for informed cancer screening

Prostate cancer is a leading cause of cancer-related deaths among men in the USA. Prostate-specific antigen (PSA) testing for screening remains controversial, with shared decision-making (SDM) recommended by professional guidelines to discuss screening's risks, benefits and uncertainties. Despite these recommendations, SDM is underused, with only 10% of men receiving comprehensive SDM. This quality improvement project aimed to improve SDM documentation and the implementation of PSA screening in an urban safety-net, resident-led primary care clinic.

We implemented a continuity clinic note template with a specific SDM 'dot phrase' to improve the documentation and execution of SDM conversations. Our primary aim was to increase SDM documentation for prostate cancer screening, with a secondary aim to improve follow-up on abnormal PSA values. The intervention included men aged 55-69 years. Preintervention, residents were educated on SDM and PSA screening. Postintervention, patient charts were reviewed for documentation rates and screening outcomes. Feedback was collected during dedicated sessions. Finally, comparative statistics were conducted between baseline preintervention and eligible postintervention cohorts.

SDM documentation improved significantly from 7.1% preintervention to 37.2% postintervention (p<0.001). PSA screening rates increased from 31.5% to 37.8% (p=0.155), though not significantly. Notably, 49.3% of patients declined PSA testing post-SDM, and 68.5% of previously screened patients were up to date with PSA testing. Residents reported challenges with SDM implementation, including time constraints and patient acuity.

Templated notes and dot phrases significantly improved SDM documentation, both compared with our clinic baseline rates and compared with recent reported national rates, overall enhancing standardised preventive care in primary care. Although PSA screening rates improved, challenges such as time limitations and patient no-shows impacted the intervention's effectiveness. Future cycles will address these barriers to improve outcomes further.