PROSTATE CANCER SCREENING DECISION MAKING: THE DECISIONS SURVEY

Purpose: To evaluate the medical-decision making process for prostate cancer screening. Methods: The National Survey of Medical Decisions (DECISIONS) was a computer-assisted random-digit-dialing telephone survey of a nationally representative sample of 3,010 English-speaking adults age 40 and older. We selected 375 men, who had either undergone prostate-specific antigen (PSA) testing or discussed prostate cancer screening in the previous 2 years with health care providers (HCP), to complete a 46-item prostate module. We asked subjects about socioeconomic and health status, testing discussions with HCP, the decision-making process, the importance of various decision factors and sources of information (using 10-point rating scales with 10 = most important), and knowledge of prostate cancer and PSA testing. We used descriptive statistics weighted for the sampling frame to characterize the subjects and the decision-making process. Results. Overall, 42% of men in the national sample reported recent PSA testing, including 86% of those completing the module. Among the subjects, 59% were age 50 to 69 years, 71% were white, 83% were married, 31% earned $100,000+ annually, and 49% reported excellent/very good health status. Health care providers raised the idea of PSA testing more often than subjects (68% vs. 32%) and 71% of HCP recommended testing. Subjects reported that 68% of HCP discussed the pros of testing a lot/some, while 69% did not discuss the cons at all. Only 50% of subjects reported being asked for their screening preference, though 57% described the decision making as shared and 59% were extremely confident (rating score = 10) in their screening decision. HCP advice (50%) and the opportunity for early detection (71%) were frequently cited as extremely important decision factors (rating score = 10); 50% reported that HCP were an extremely important source of information. Overall, 58% felt themselves to be well informed about PSA testing, though 43% failed to correctly answer any of the 3 knowledge questions asked. Conclusions: HCP strongly influenced decisions about PSA testing. However, HCP rarely addressed the cons of testing and, although subjects felt well informed, knowledge scores were poor. Many patients make PSA testing decisions without balanced discussions of decision consequences and with limited knowledge about prostate cancer screening.