Prostate-Specific Antigen Testing Initiation and Shared Decision-Making: Findings from the 2000 and 2015 National Health Interview Surveys

Discussion

In 2000 and 2015, more than 70% of men who underwent PSA testing in the past year reported that their physicians were the first to suggest testing. Conflicting recommendations regarding PSA testing might have contributed to that high prevalence.¹ Other factors might include physician beliefs about PSA screening effectiveness, perceived community standard of care, and malpractice concerns.² Medicare reimbursement for annual PSA testing might contribute to the willingness of physicians to propose or support testing.

PIPT is positively associated with 2 or more comorbid conditions and the number of patient encounters with clinicians. More patient encounters may increase a clinician's opportunity to suggest the test. This study suggests that men with prostate cancer family history are more likely to first suggest PSA testing. In 2017, the US Preventive Task Force released draft recommendations, instead of against screening among men of all ages, calling for individualized decision making after discussion of potential benefits and harms of PSA testing among men aged 55 years to 69 years.³ In our study, more than two-thirds of men who were screened reported that they had never discussed advantages and disadvantages of PSA testing with physicians, a finding consistent with previous reports.^4,5 These results point to the challenges and needs in conducting SDM in clinical practice.

Limitations of our study include self-reported data (which may be less accurate than medical records), results that may not be representative of nonrespondents, and lack of details on the relationship to the patient when “someone else requested the test.”