PCa screening: Shared decision making infrequent

Shared decision making occurs in only one-third of men who have made a decision about prostate cancer screening, according to findings from a new study that one leading prostate cancer expert said were not at all surprising.

The national survey of patients, reported online in the American Journal of Preventive Medicine (June 5, 2014), examined data from more than 1,100 people aged 50 years and older who made decisions about whether to undergo screening for prostate, breast, or colorectal cancer in the previous 2 years. Participants were asked whether their physicians discussed the pros and cons of screening and of forgoing screening, and if they had been given a choice whether or not to be screened.

Shared decision making was lowest among women for breast cancer screening (27%), followed by men for prostate cancer screening (34%), and both women and men for colorectal cancer screening (38%), as reported by the Health Behavior News Service, part of the Center for Advancing Health.

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Overall, physicians were more likely to discuss the pros of a given screening procedure (51%-67%, depending on the type of screening) than the cons (7%-14%), according to survey participants. Most physicians offered opinions that primarily favored screening.

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Physicians were more likely to ask men (70% for prostate cancer and 71% for colorectal cancer) whether they wanted testing than they were to ask women (43% for breast cancer and 57% for colorectal cancer), reported lead author Richard M. Hoffman, MD, MPH, of the University of New Mexico School of Medicine in Albuquerque.

Peter Albertsen, MD, of the University of Connecticut, Farmington, said the study’s findings about prostate cancer screening did not come as a surprise.

He said the lack of discussion stems from two primary factors, one being too much to cover and too little time in an office visit. In addition, “Many clinicians have not been trained in issues surrounding epidemiology and public health. They feel uncomfortable having these discussions or do not know what to discuss,” said Dr. Albertsen, a member of the Urology Times Editorial Council, who was not involved in the study.

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