Recent patterns in shared decision making for prostate-specific antigen testing in the United States

Stacey A. Fedewa, Ted Gansler, Robert Smith, Ann Goding Sauer, Richard Wender, Otis W. Brawley, Ahmedin Jemal

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


PURPOSE Previous studies report infrequent use of shared decision making for prostate-specific antigen (PSA) testing. It is unknown whether this pattern has changed recently considering increased emphasis on shared decision making in prostate cancer screening recommendations. Thus, the objective of this study is to examine recent changes in shared decision making. METHODS We conducted a retrospective cross-sectional study among men aged 50 years and older in the United States using 2010 and 2015 National Health Interview Survey (NHIS) data (n = 9,598). Changes in receipt of shared decision making were expressed as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Analyses were stratified on PSA testing (recent [in the past year] or no testing). Elements of shared decision making assessed included the patient being informed about the advantages only, advantages and disadvantages, and full shared decision making (advantages, disadvantages, and uncertainties). RESULTS Among men with recent PSA testing, 58.5% and 62.6% reported having received ≥1 element of shared decision making in 2010 and 2015, respectively (P =.054, aPR = 1.04; 95% CI, 0.98-1.11). Between 2010 and 2015, being told only about the advantages of PSA testing significantly declined (aPR = 0.82; 95% CI, 0.71-0.96) and full shared decision making prevalence significantly increased (aPR = 1.51; 95% CI, 1.28-1.79) in recently tested men. Among men without prior PSA testing, 10% reported ≥1 element of shared decision making, which did not change with time. CONCLUSION Between 2010 and 2015, there was no increase in shared decision making among men with recent PSA testing though there was a shift away from only being told about the advantages of PSA testing towards full shared decision making. Many men receiving PSA testing did not receive shared decision making.

Original languageEnglish (US)
Pages (from-to)139-144
Number of pages6
JournalAnnals of family medicine
Issue number2
StatePublished - Mar 1 2018
Externally publishedYes


  • Decision making
  • Early detection of cancer
  • Prostate-specific antigen

ASJC Scopus subject areas

  • Family Practice


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