National Evidence on the Use of Shared Decision Making in Prostate-specific Antigen Screening

Paul K. J. Han, MD, MA, MPH; Sarah Kobrin, PhD; Nancy Breen, PhD; Djenaba A. Joseph, MD, MPH; Jun Li, MD, PhD; Dominick L. Frosch, PhD; Carrie N. Klabunde, PhD


Ann Fam Med. 2013;11(4):306-314. 

In This Article


For the 2010 NHIS, interviews were conducted with 27,157 adults (response rate 60.8%). Of 4,217 men aged 50 to 74 years, 3,427 met eligibility criteria and were included in the study population (Figure 1). Study population characteristics are shown in Table 1. Approximately 55.8% of men reported ever having a PSA test, and 65.5% of them had testing within the past year. Physician recommendation for PSA screening was reported by 52.5%. No past screening was reported by 44.2%, low-intensity screening by 27.8%, high-intensity screening by 25.1%.

Figure 1.

Study population of men aged 50–74 years, National Health Interview Survey, 2010.

Table 2 shows the independent and joint distribution of shared decision-making elements. No physician-patient discussion of either advantages or disadvantages was reported by 65.1% of men, whereas discussion of advantages only was reported by 16.9%, disadvantages only by 0.9%, advantages and disadvantages by 17.0%, and uncertainty by 12.1%. Only 8.0% reported discussion of all 3 elements (full shared decision making). Partial shared decision making (1 to 2 discussion elements) was reported by 27.8%, ranging from 2.5% for disadvantages only to 14.6% for advantages only.

Table 3 shows the factors associated with PSA screening intensity in adjusted analyses (unadjusted analyses are in Supplemental Table 1, available at Increasing age, higher education, usual source of medical care, and physician recommendation were associated with higher intensity screening. Partial shared decision making (1 to 2 discussion elements) was associated with higher intensity screening (compared with no shared decision making), but full shared decision making (all 3 discussion elements) was not. Figure 2 displays these data in terms of unadjusted column percentages, showing the extent of shared decision making in the nonscreening, low-intensity, and high-intensity screening groups. Of nonscreened men, 88% (95% CI, 86.2%–90.1%) reported no shared decision-making elements and 3% (95% CI, 2.0%–4.2%) reported all 3; corresponding proportions for men undergoing high-intensity screening were 39% (95% CI, 35.0%–43.3%) and 13% (95% CI, 9.9%–15.6%).

Figure 2.

Extent of shared decision making by intensity level of PSA screening, 2010 National Health Interview Survey.

With respect to predictors of shared decision making, 4 factors were positively associated with physician-patient discussions of advantages and disadvantages (Table 4): black race, Hispanic ethnicity, physician recommendation, and discussion of uncertainty. Two factors—higher education, discussion of advantages and disadvantages—were positively associated with discussion of uncertainty, whereas no or only public health insurance was negatively associated.