Shared decision-making and informed choice for the early detection of prostate cancer in primary care

33 Background: In April 2017, the United States Preventive Services Task Force published a draft statement recommending that clinicians inform men ages 55 to 65 about the potential benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer. The HIT-OVERUSE study is an ongoing 2 year group randomized study in 20 primary care practices to test a practice-based intervention to reduce overuse, including avoidance of routine PSA screening without shared decision making. The purpose of this report is to present qualitative findings about approaches participating practices have adopted to facilitate shared decision-making for PSA screening. Methods: Eleven practices in ten states randomized to the HIT-OVERUSE intervention group have hosted on-site visits for academic detailing and participatory planning and sent two practice representatives to a one day meeting to share ‘best practices.’ Detailed notes from site visits, follow-up emails, and the ‘best practice’ meeting were reviewed to identify strategies adopted by practices to facilitate shared decision-making for PSA screening for prostate cancer screening. Results: All practices adopted at least one strategy to promote shared-decision making for PSA screening. Four practices removed standing orders for routine PSA screening. Four practices educated their clinical staff about the test; three developed scripts for staff to use when asked by patients about the test. Six practices began using patient education handouts about PSA screening. One provider started showing a brief YouTube video with patients, while another practice developed a slide show to show in the waiting room. Most providers in nearly all practices reported modifying their conversation about PSA screening with patients to include some discussion about the benefits and the harms of screening. Conclusions: Primary care practices participating an intervention to reduce overuse have adopted varied approaches to facilitate shared-decision making for prostate cancer screening. While having face-to-face conversations is one approach, other strategies may employ staff or utilize patient education or videos to convey the benefits and harms of screening.

Download Full-text

Reducing overuse of PSA screening in primary care practices.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.37 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 37-37

Author(s):

Cara B Litvin

Keyword(s):

Prostate Cancer ◽

Primary Care ◽

Decision Making ◽

Shared Decision Making ◽

Shared Decision ◽

Psa Screening ◽

The Past ◽

Care Practices ◽

Primary Care Practices ◽

And Control

37 Background: The United States Preventive Services Task Force and the American Urological Association both recommend against routine PSA-based screening for prostate cancer in men 70 years and older and, for men younger than 70, recommend shared-decision making to discuss the potential benefits and harms of screening before a PSA is ordered. The HIT-OVERUSE study was a 2 year group randomized study from August 2016 thru July 2018 to test a practice-based intervention to reduce overuse in primary care practices, including avoidance of routine PSA screening without shared decision-making. The purpose of this report is present the impact of this intervention on PSA screening. Methods: Twenty one primary care practices in 19 states volunteered to participate in the study. Prior to randomization, all providers received academic detailing on prostate cancer screening recommendations. Eleven practices randomized to the intervention group then received quarterly performance reports, hosted site visits for participatory planning and sent two practice representatives to a one day meeting to share ‘best practices’. The ten control practices only received performance reports. Changes in PSA testing in the past year (excluding patients with prostate cancer) were compared in control and intervention practices. Results: At the patient level, there was a significantly larger unadjusted reduction in PSA screening in men ages 40 to 69 in the past year between intervention practices (28.6 % to 19.0%) and control practices (16.5% to 12.7%) (p<0.0001). There was also a significantly larger unadjusted reduction in PSA screening in men ages 70 and older in the past year between intervention practices (25.7% to 14.7%) and control practices (21.9% to 15.6%) (p<0.0001). Adjusted changes will also be presented. Conclusions: A practice-based intervention to reduce routine PSA-screening performed without shared decision-making resulted in a greater reduction in PSA screening compared to provision of academic detailing alone. Further research could elucidate whether this type of intervention results in increased shared decision-making conversations with patients.

Download Full-text

6. Co-design to inform shared decision-making tools for pregnant women with FGM in primary care

Journal of Obstetrics and Gynaecology Canada ◽

10.1016/j.jogc.2019.11.045 ◽

2020 ◽

Vol 42 (2) ◽

pp. e22

Author(s):

Angela Dawson

Keyword(s):

Primary Care ◽

Decision Making ◽

Pregnant Women ◽

Shared Decision Making ◽

Shared Decision

Download Full-text

PD40-07 ADDRESSING HEALTH LITERACY IMPROVES SHARED DECISION MAKING IN UNDERSERVED AFRICAN AMERICAN PROSTATE CANCER PATIENTS

The Journal of Urology ◽

10.1097/ju.0000000000000920.07 ◽

2020 ◽

Vol 203 ◽

pp. e817-e818

Author(s):

Kerry Kilbridge ◽

William Martin-Doyle* ◽

Christopher Filson ◽

Quoc-Dien Trinh ◽

Sierra Williams ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

African American ◽

Health Literacy ◽

Cancer Patients ◽

Shared Decision Making ◽

Shared Decision

Download Full-text

Preparing Patients with Early Stage Prostate Cancer to Participate in Clinical Appointments Using a Shared Decision Making Training Video

Medical Decision Making ◽

10.1177/0272989x211028563 ◽

2021 ◽

pp. 0272989X2110285

Author(s):

Karen Scherr ◽

Rebecca K. Delaney ◽

Peter Ubel ◽

Valerie C. Kahn ◽

Daniel Hamstra ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Early Stage ◽

Controlled Trial ◽

Treatment Decision ◽

Shared Decision ◽

Plain Language ◽

Training Video ◽

Video Group

Background Rates of shared decision making (SDM) are relatively low in early stage prostate cancer decisions, as patients’ values are not well integrated into a preference-sensitive treatment decision. The study objectives were to develop a SDM training video, measure usability and satisfaction, and determine the effect of the intervention on preparing patients to participate in clinical appointments. Methods A randomized controlled trial was conducted to compare a plain-language decision aid (DA) to the DA plus a patient SDM training video. Patients with early stage prostate cancer completed survey measures at baseline and after reviewing the intervention materials. Survey items assessed patients’ knowledge, beliefs related to SDM, and perceived readiness/intention to participate in their upcoming clinical appointment. Results Of those randomized to the DA + SDM video group, most participants (91%) watched the video and 93% would recommend the video to others. Participants in the DA + SDM video group, compared to the DA-only group, reported an increased desire to participate in the decision (mean = 3.65 v. 3.39, P < 0.001), less decision urgency (mean = 2.82 v. 3.39, P < 0.001), and improved self-efficacy for communicating with physicians (mean = 4.69 v. 4.50, P = 0.05). These participants also reported increased intentions to seek a referral from a radiation oncologist (73% v. 51%, P = 0.004), to take notes (mean = 3.23 v. 2.86, P = 0.004), and to record their upcoming appointments (mean = 1.79 v. 1.43, P = 0.008). Conclusions A novel SDM training video was accepted by patients and changed several measures associated with SDM. This may be a scalable, cost-effective way to prepare patients with early stage prostate cancer to participate in their clinical appointments. [Box: see text]

Download Full-text

Prostate disorders diagnosis and management review with an osteopathic component

Osteopathic Family Physician ◽

10.33181/13061 ◽

2022 ◽

pp. 23-28

Author(s):

Elizabeth V. George ◽

Helaine Larsen

Keyword(s):

Prostate Cancer ◽

Primary Care ◽

Decision Making ◽

Care Setting ◽

Primary Care Setting ◽

Prostate Cancer Screening ◽

Management Approach ◽

Shared Decision ◽

Laboratory Examination ◽

Prostate Disease

Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation should include a thorough history, physical examination, laboratory examination and imaging, if necessary. This article aims to provide a diagnostic and management approach for prostate disease.

Download Full-text

Depressed Latinx Older Adults’ Shared Decision-Making Preferences

10.31234/osf.io/6z25r ◽

2021 ◽

Author(s):

Sara Romero ◽

Patrick Raue ◽

Andrew Rasmussen

Keyword(s):

Primary Care ◽

Decision Making ◽

Puerto Rican ◽

Shared Decision Making ◽

Decision Making Process ◽

Shared Decision ◽

Medical Conditions ◽

Depression Severity ◽

Related Information ◽

Health Related

The shared decision-making (SDM) model is the optimal patient-centered approach to reduce racial and ethnic health disparities in primary care settings. This study examined decision-making preferences and the desire to be knowledgeable of health-related information of a multiheritage group of depressed older Latinx primary care patients. The primary aim was to determine differences in treatment preferences for both general medical conditions and depression and desire to be knowledgeable of health-related information between older Puerto Rican adults compared to older non-Puerto Rican Latinx adults. We also examined whether depression severity moderated those relationships. A sample of 178 older Latinx patients were assessed on measures of decision-making preferences, information-seeking desires, and depression severity. Regression models indicated depression severity moderated the relationship between Latinx heritage and decision-making preferences that relate to general medical decisions, but not depression treatment. Specifically, Puerto Ricans with high levels of depression preferred to be more active in making decisions related to general medical conditions compared to non-Puerto Rican patients who preferred less active involvement. There was no difference between groups at low levels of depression as both groups preferred to be similarly active in the decision-making process. This investigation adds to the literature by indicating between-group differences within a Latinx older adult sample regarding decision-making preferences and the desire to be informed of health-related information. Future research is needed to identify other sociocultural characteristics that contribute to this disparity between Latinx heritage groups in their desires to participate in the decision-making process with their primary care provider.

Download Full-text