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. In this Review, the authors discuss shared decision-making for prostate cancer screening in terms of definition, prevalence and methods, including decision aids. Facilitators and barriers to shared decision-making are also discussed. Shared decision-making (SDM) about prostate-specific antigen screening should be collaborative between patients and physicians, and should consist of eliciting patients' preferences, providing evidence-based information about risks and benefits, and reaching a values-concordant choice.The use of SDM for prostate cancer screening is suggested by guideline groups, but SDM remains underused.Facilitators to SDM include a consistent clinician-provider relationship, trust in the clinician, having a partner, and high education level.Barriers to SDM include limited appointment times, insufficient knowledge, poor health literacy, any barrier to communication, and physician beliefs about screening.Decision aids can help to improve patients' knowledge and facilitate SDM, but are rarely used in clinical practice.