Factors associated with men's use of prostate-specific antigen screening: evidence from Health Information National Trends Survey
Introduction
Prostate cancer poses a significant public health problem in the United States as the most common non-skin cancer diagnosis and the second leading cause of cancer mortality among American men [1]. Interest in prostate cancer testing has increased since the early 1990s, with rapid uptake of prostate-specific antigen (PSA) testing for prostate cancer. Data from the 2000 National Health Interview Survey show that 41% of U.S. men aged 50 and older reported having had a PSA test within the last year [2]. PSA rates are similar to rates for colorectal cancer screening (home stool blood test within the past year or colorectal endoscopy within the past 5 years), for which a mortality benefit has been demonstrated [2]. Furthermore, given that some men may have PSA tests done without their active consent (e.g., as part of blood chemistry), self-reports of PSA use may underestimate actual testing prevalence [3], [4], [5].
Although PSA testing may play some role in recent declines in prostate cancer mortality, the data are not conclusive [1]. The U.S. Preventive Services Task Force recently reviewed the evidence on the relationship between PSA testing and prostate cancer mortality and concluded that there is insufficient evidence to support recommendations for routine screening of the general population [6], [7], [8]. Mortality data from ongoing randomized controlled trials, the U.S. National Cancer Institute's Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) Trial, and the European Randomized Study of Screening for Prostate Cancer, will not be available for several years. Furthermore, it is not clear whether the benefits of screening outweigh potential risks [6], [9], [10], [11], [12]. Positive PSA tests require additional testing that may lead to more invasive diagnostic procedures. Radical prostatectomy and radiation treatments for prostate cancer may also produce complications such as erectile dysfunction and urinary incontinence [13]. Given the lack of definitive evidence of a mortality benefit for PSA screening, most professional organizations do not recommend routine PSA screening for all age-eligible men [14]. Rather, most organizations recommend that healthcare providers discuss testing and arrive at informed decisions with their male patients over age 50 [6], [15], [16], [17].
Sociodemographic characteristics, such as age, race/ethnicity, education, and income, have been associated with PSA use in previous research [2], [18], [19], [20], [21], [22]. The prevalence of PSA use increases with age [2], [18], [20], [21], education, and income [2], [19]. Lower utilization rates have been documented among Hispanics, non-Hispanic Asians, and recent immigrants to the United States [2]. Not surprisingly, higher rates of PSA use are found among men with health insurance and a usual source of healthcare [2], [19], [20], [21]. Provider recommendations for PSA testing also are associated with higher utilization rates [22].
The widespread use of PSA testing, coupled with controversies about PSA screening, have raised awareness about the need for men to understand the benefits and limitations of PSA tests. Thus, it is appropriate to examine patient decision making with regard to PSA test use [23]. Two complementary healthcare decision making models that have been proposed are shared decision making (SDM) and informed decision making (IDM). SDM occurs in clinical settings and is characterized by active provider involvement, mutual information sharing between the patient and provider, and expressions of patient preferences [24]. IDM occurs when patients understand their disease or condition and the particular test, regimen, or treatment under consideration. SDM and IDM are mutually supportive decision making processes wherein the patient (1) understands the risks and seriousness of a given health matter, (2) understands the risks, benefits, uncertainties, and alternatives to available preventive services, (3) has considered his or her values and preferences regarding the preventive service, and (4) has participated in decision making about the service at a desired and comfortable level [23], [24]. While SDM is limited to clinical settings, IDM may be cultivated both within and outside of the clinical setting. Moreover, IDM on the part of participants is required for SDM; thus, patients must be informed to share in the decision making process.
SDM and IDM are particularly relevant to PSA test use because many professional organizations recommend that healthcare providers tailor decisions about PSA testing to individual patients by discussing the risks and benefits of the test and by taking patients' risks, values, and preferences into account [6], [15], [16], [17]. Within the SDM paradigm, men's decisions about PSA testing are likely to be influenced by communication with healthcare providers including whether healthcare providers recommend PSA. IDM is not limited to the clinical setting, and does not require real-time communication between patients and heath care providers. However, if patients do not get the information from healthcare providers, IDM requires commitment beyond the physician's office to help men understand what the PSA test is, as well as its potential benefits and limitations. The attention men pay to health information and health information seeking behavior is likely to influence the decision making process regarding PSA testing.
The purpose of this report is to (1) examine PSA test use among subgroups defined by key demographic characteristics and (2) explore the association of PSA use with factors relevant to SDM and IDM. These include respondents' perceptions of healthcare providers' communication style and attention to health information and cancer information-seeking behavior.
Section snippets
Data source
Data for this investigation are from the 2003 Health Information National Trends Survey (HINTS). HINTS collects nationally representative data every 2 years on the American public's need for, access to, and use of cancer-relevant information (see URL for complete copy of document: http://cancercontrol.cancer.gov/hints/).
The conceptual framework that guided the development of HINTS proposes that health behaviors are influenced by a two-stage process of consumer-oriented health communication [25]
Bivariate analyses
Sociodemographic and healthcare access characteristics for the total sample as well as frequencies and percentages for respondents who reported ever (n = 515) and never (n = 379) having had PSA tests are shown in Table 1. Most men were aged 50–64 and were white. Compared with respondents who ever had PSA, a greater proportion of respondents who never had PSA tests were Hispanic, had annual incomes of $25,000 or less, had less than a high school education, did not have health insurance, and did
Discussion
Patterns of PSA test use in our sample are similar to those observed in other national samples [2]. Over half the men reported that they ever had one or more PSA tests. Consistent with previous research [2], [18], [19], [20], [21], [22], age, education, health insurance, and usual source of care were associated with PSA test use. Men aged 65–74, with at least some college education, with health insurance, and a usual source of care were more likely to report having a PSA test. Lower use of
Conclusions
The lack of sufficient evidence to support recommendations for population-wide prostate cancer screening and documented deficits in patients' knowledge of PSA testing [54], [55] underscores the value of both SDM and IDM in supporting men's decisions about PSA testing. Healthcare providers have a critical role in informing patients and involving them in decisions about PSA testing. Inconsistencies in healthcare providers' willingness, ability, and available time to share information about PSA
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Brief report: Impact of healthcare quality on prostate specific antigen screening for the early detection of prostate cancer
2019, Preventive Medicine ReportsCitation Excerpt :It's unclear why quality would positively impact PSA screening in White men and not in non-Whites. Unlike White men, non-White men are known to experience lower healthcare quality and health outcomes (Finney Rutten et al., 2005). It's possible that unmeasured factors in our study, such as provider-patient race concordance, communication barriers, and healthcare access were more important drivers of PSA screening in non-Whites (Finney Rutten et al., 2005; Collins et al., 2002; Saha et al., 1999).
Primary Care Physicians Beliefs about Prostate-Specific Antigen Evidence Uncertainty, Screening Efficacy, and Test Use
2018, Journal of the National Medical AssociationCitation Excerpt :Results from the current study confirm the earlier finding that regardless of belief, PCPs reported high levels of PSA use.20 PCP characteristics related to offering the PSA test for prostate cancer screening have been noted in other studies.15,18,23 However, less research has been presented that explores the relationship among measures of evidence uncertainty and screening efficacy with offering the PSA test.19,24
Gender Identity Disparities in Cancer Screening Behaviors
2018, American Journal of Preventive MedicineCitation Excerpt :A key finding from this study was the significantly lower Pap test rates of trans men and GNC individuals, and reduced rates of CRC screenings and mammography among trans women. Given the importance of provider recommendation for motivating cis people to screen for cervical cancer9,23 and prostate cancer,24 the relationship between provider practices and screening disparities should be further investigated in TGNC samples. Though not included in this study, potential moderators of cancer screening like transgender identity disclosure, experiences of provider discrimination,3,5,9 and provider cultural competency25 should be explored in future research.
What Have Patients Been Hearing From Providers Since the 2012 USPSTF Recommendation Against Routine Prostate Cancer Screening?
2017, Clinical Genitourinary CancerCitation Excerpt :A similar decrease in PSA test uptake has been recorded in the detection of PCa patients from Surveillance, Epidemiology, and End Results Program data11 and primary care physicians' prescription for the PSA test in the wake of the seminal report by the USPSTF in 2012.10 Rutten et al studied the 2003 version of HINTS data to understand the association between PSA use and patient decision-making and found that men aged 65 to 74 years, with a college degree and men who attend to and seek out health information were more likely to report having been tested for PCa.12 Although our study supported their findings, that in the more recent years college graduates who sought health information were tested more frequently, we found that men aged 51 to 65 years were most likely to have the test done.
Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities
2016, Preventive MedicineCitation Excerpt :This contrasts with the very low prevalence of colorectal cancer screening – which efficacy has been clearly demonstrated – recently reported using the same source population (Fedewa et al., 2015). The rise is striking given the serious debate regarding recommendations and could be, at least in part, attributed to the rapid uptake of PSA (Finney Rutten et al., 2005; Potosky et al., 1995; Scales et al., 2008). Similar high prevalence was found among men who reported having a general practitioner visit in the last 12 months, suggesting that general practitioners were major facilitators of PCa exam despite the lack of robust evidence on PCa screening efficacy.