Shared decision making in prostate-specific antigen testing with men older than 70 years

Abstract

Background: Little is known about how shared decision making (SDM) is being carried out between older men and their health care providers. Our study aimed to describe the use of SDM key elements and assess their associations with prostate-specific antigen (PSA) testing among older men. Methods: We conducted descriptive and logistic regression modeling analyses using the 2005 and 2010 National Health Interview Survey data. Results: Age-specific prevalence of PSA testing was similar in 2005 and 2010. In 2010, 44.1% of men aged <70 years had PSA testing. Only 27.2% (95% confidence interval, 22.2-32.9) of them reported having discussions about both advantages and disadvantages of testing. Multiple regression analyses showed that PSA-based screening was positively associated with discussions of advantages only (P > .001) and with discussions of both advantages and disadvantages (P > .001) compared with no discussion. Discussion of scientific uncertainties was not associated with PSA testing. Conclusions: Efforts are needed to increase physicians' awareness of and adherence to PSA-based screening recommendations. Given that discussions of both advantages and disadvantages increased the uptake of PSA testing and discussion of scientific uncertainties has no effect, additional research about the nature, context, and extent of SDM and about patients' knowledge, values, and preferences regarding PSA-based screening is warranted. (J Am Board Fam Med 2013;26:401- 408.).