Shared decision making for prostate cancer screening: Reality or farce?

107 Background: A core tenant of major cancer society guidelines regarding prostate cancer screening (PSAS) is that providers discuss both the advantages and disadvantages of screening with eligible patients in a shared decision making (SDM) process. We sought to determine contemporary trends of SDM in regards to PSAS. Methods: Consistent with the AUA guidelines for PSAS, data was abstracted from the 2012-2016 Behavioral Risk Factor Surveillance System for men 55-69, without a personal history of prostate cancer, and having answered all questions within the PSAS module. PSAS occurred if a man had a PSA test within the last two years for reasons other than "a prostate problem” or “prostate cancer”. SDM occurred if the respondent was informed about both advantages and disadvantages of PSAS by a health professional. Descriptive statistics were generated for demographic covariates by year. The Chi-Square test was used to compare the distribution of covariate proportions amongst years. Separate multivariable regression models were built to identify independent predictors of both receipt of PSA screening and SDM. Results: A weighted estimate of 56.7 million men (n = 138,492) met inclusion criteria. Reported rates of PSAS decreased each year (56.7% in 2012 to 52.6% in 2014 to 49.1% in 2016, p < 000.1). There were no significant changes in rates of SDM (p = 0.82); in all three years, less than one-third of respondents reported SDM. After controlling for known confounders, possession of a personal physician (OR 2.24,95%CI 2.02-2.48), receipt of information regarding the advantages of PSAS (OR 3.93, 95%CI 3.63-4.26), and receiving a physician recommendation to undergo PSAS (OR 7.78, 95%CI 7.25-8.35) were most strongly associated with odds of undergoing PSAS. Odds of reporting participation in SDM were strongest amongst black respondents (2.09 95%CI 1.92-2.28) and those who received a physician recommendation to undergo PSAS (OR 4.64, 95%CI 4.32-4.99). Conclusions: Despite recommendations that physicians engage patients in a SDM process, our findings suggest that less than a third of patients are advised of both the advantages and disadvantages of PSAS. With the likely revision of the USPSTF PSAS recommendation to Grade C, a renewed effort towards SDM is needed.