Shared decision-making improves equitable prostate cancer screening

Key takeaways:

• Among patients who did not receive shared decision-making, Black and Hispanic men were less likely to be screened for prostate cancer.
• The use of shared decision-making mitigated these disparities.

Shared decision-making could attenuate racial disparities in prostate cancer screening, according to research published in the American Journal of Preventive Medicine.

Prostate-specific antigen (PSA) screening is more common among white men than Black and Hispanic men, Nicola Frego, MD, a researcher at Brigham and Women’s Hospital’s division of urological surgery and center for surgery and public health, and colleagues wrote.

To combat the disparities, in 2018, the United States Preventive Services Task Force recommended shared decision-making (SDM) for men aged 55 to 69 years and encouraged considering a patient’s race and ethnicity for PSA screening, the researchers wrote.

“Although the impact of PSA screening in reducing prostate cancer mortality remains uncertain, the lower use of PSA screening in underserved populations is noteworthy and may contribute to race-based disparities in prostate cancer outcomes, including higher mortality among Black and Hispanic men,” they wrote. “While race-based differences in prostate cancer diagnosis and care are well documented, strategies to overcome these inequalities are struggling to take hold.”

SDM is a patient-centered process in which a patient and their physician make health care decisions together, blending patient preferences with clinical evidence, the researchers wrote. Research indicates that those from underrepresented racial and ethnic populations have lower SDM participation, shorter interactions that are less patient-centered and lower trust in recommendations from their physician.

“In this context, the extent of adherence to current guidelines among racial/ethnic groups and the influence of SDM on racial and ethnic disparities in prostate cancer screening utilization remain uncertain,” they wrote.

So, Frego and colleagues conducted a cross-sectional study to evaluate whether a proxy SDM variable impacted racial and ethnic disparities in PSA screening. The researchers included data from 26.8 million men aged 55 to 69 years who answered questions regarding PSA screening in the 2020 Behavioral Risk Factor Surveillance System survey.

Frego and colleagues found that estimated SDM was a significant predicator of screening for PSA (adjusted OR = 2.65; 95% CI, 2.36-2.98) and the interaction between estimated SDM and race or ethnicity on screening for PSA was significant.

Of the participants who did not have SDM, both Hispanic (OR = 0.51; 95% CI, 0.39-0.68) and Black (OR = 0.77; 95% CI, 0.61-0.97) men were significantly less likely to undergo screening for PSA than white men.

However, among those who reported SDM, the researchers did not observe any significant race-based differences in PSA screening. They wrote that this was their “most significant finding.”

“Underserved populations may experience cultural and belief differences and stigma about cancer, and disparities in prostate cancer survival outcomes may be due to the lack of screening, resulting in delayed diagnosis,” they wrote. “These results suggest that health care professionals engaging in SDM may play a crucial role in reducing disparities in PSA screening prevalence and improving outcomes.”