Prostate Cancer Screening Shared Decision Making and Prostate-Specific Antigen Testing in Black and Non-Black Men in...

Black men experience disproportionate prostate cancer mortality compared with men of other races. As of 2018, major guidelines concur that all men make informed decisions about whether to be screened for prostate cancer after a discussion with their clinician. The objectives of this study were to determine the frequency at which clinicians document prostate cancer screening shared decision-making (SDM) conversations, to examine whether SDM documentation rates differ by race and other sociodemographic factors, and to evaluate whether SDM affects rates of prostate cancer screening.

We conducted retrospective chart reviews of a random sample of men (N=600) aged 45 to 69 years seen within an academic family medicine practice in South Carolina in 2019-2020. We used χ² analyses to compare documentation of a prostate cancer SDM conversation and prostate-specific antigen (PSA) testing by race, age, family history of cancer, family history of prostate cancer, colon cancer screening adherence, and insurance. Logistic regressions assessed the effect of SDM, race, age, and insurance status on the completion of screening PSAs.

SDM conversations were documented for 7.3% of Black men and 5.3% of non-Black men (P=0.37). Screening PSAs were ordered in 39.7% of Black men and 36.0% of non-Black men (P=0.41). SDM conversations were positively associated with prostate cancer screening in all men (71.8% vs 35.6%, P<0.01) and Black men specifically (85.0% vs 35.7%, P<0.01).

Our results indicate very low rates of prostate cancer SDM in Black and non-Black men. Men with documented SDM conversations were significantly more likely to receive prostate cancer screening. Study results suggest the need for increased SDM in all patients and the need for improved clinician documentation of SDM conversations to evaluate whether men receive the standard of care regarding prostate cancer screening.