National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening

被引:78
|
作者
Han, Paul K. J. [1 ,2 ]
Kobrin, Sarah [3 ]
Breen, Nancy [4 ]
Joseph, Djenaba A. [5 ]
Li, Jun [5 ]
Frosch, Dominick L. [6 ,7 ]
Klabunde, Carrie N. [4 ]
机构
[1] Maine Med Ctr, Res Inst, Portland, ME 04101 USA
[2] Tufts Univ, Sch Med, Boston, MA 02111 USA
[3] Natl Canc Inst, Div Canc Control & Populat Sci, Behav Res Program, Rockville, MD USA
[4] Natl Canc Inst, Div Canc Control & Populat Sci, Appl Res Program, Rockville, MD USA
[5] Ctr Dis Control & Prevent, Atlanta, GA USA
[6] Palo Alto Med Fdn, Res Inst, Palo Alto, CA 94301 USA
[7] Univ Calif Los Angeles, Dept Med, Los Angeles, CA USA
关键词
prostate-specific antigen; mass screening; decision making; PRIMARY-CARE PHYSICIANS; RANDOMIZED CONTROLLED-TRIAL; INFORMED DECISIONS; SELF-REPORTS; HEALTH-CARE; CANCER; MEN; SERVICES; ACCURACY; CONCORDANCE;
D O I
10.1370/afm.1539
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. CONCLUSIONS Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.
引用
收藏
页码:306 / 314
页数:9
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