Behind closed doors: What happens when patients and providers talk about prostate-specific antigen screening?: Survey of the effects of a community-based intervention

Abstract

Background: Prostate-specific antigen (PSA) screening is controversial because of uncertainty about whether it reduces mortality and whether the potential benefits outweigh the harms. Given these uncertainties, many medical associations recommend using an informed decision-making (IDM) process for making decisions about PSA screening, so that men can make well informed decisions that reflect their values and preferences. Objective: The aim of this paper was to describe the communication exchange between men and their providers regarding PSA screening and the outcomes associated with having a discussion about screening from the patient perspective. Methods: We evaluated survey results obtained at baseline and approximately 12 months post-intervention. Baseline data collection took place in community-based organizations, and follow-up data were collected by mail. Men between 40 and 80 years of age who had not been diagnosed with prostate cancer were eligible for the study. We implemented a multicomponent, community-based intervention designed to help men make informed decisions about PSA screening. Primary outcome measures included characteristics of patient-provider discussions, screening behavior, feeling informed and satisfied, and patients' preferred and actual levels of involvement in screening decisions and concordance between the two. Results: Overall, 59% of men (220 of 373) had a discussion with a healthcare professional about the PSA screening test. Older men (those aged ?50 years), Black men, and those who were married were more likely to talk to a provider. When a discussion did occur, two out of three men said that the discussion affected their decision making, and one-quarter changed their screening choice as a result. According to patients, there was apparent variation regarding the extent to which providers recommended the PSA test: 68% of providers recommended it and 3% did not recommend it. One in ten men said that the provider ordered the test without making a recommendation, while 15% of men said that providers did not make a recommendation and wanted the patient to decide. We found that the discussion between the patient and the provider about PSA screening was significantly associated with a greater probability of feeling informed and higher levels of satisfaction with the decision that was made. Most men preferred to be and were involved in the PSA screening decision collaboratively with their providers. When preferred and actual levels of involvement were concordant (i.e. men participated at their preferred level) and when men asked questions, men reported feeling more informed and satisfied about the screening decision. Conclusion: Ongoing education about the US Preventive Services Task Force (USPSTF) recommendation with respect to PSA screening should occur not only at the patient level but also at the provider level. More widespread adoption of the IDM process, which inherently involves building a patient's self-efficacy and skills needed to engage in it, is likely to take time.