Does Shared Decision-Making for Prostate Cancer Screening Among African American Men Happen? It Depends on Who You Ask

Allen, Jennifer D.; Porteny, Thalia; Kaplan, Amy; Ladin, Keren; Monahan, Kyle M.; Berry, Donna L.

doi:10.1007/s40615-021-01064-x

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…These factors likely contribute to the observed decreased perception of shared decision‐making and heightened recollection of discussion of risks of PSA testing. Other studies have found that these factors shape patient perspectives in shared‐decision‐making independent of physician intentions 14 . In other contexts, medical mistrust among AA patients has been linked with lower rates of colorectal cancer screening 15 and with delayed preventative health care utilization 13 …”

Section: Discussionmentioning

confidence: 99%

“…Other studies have found that these factors shape patient perspectives in shared-decision-making independent of physician intentions. 14 In other contexts, medical mistrust among AA patients has been linked with lower rates of colorectal cancer screening 15 and with delayed preventative health care utilization. Note: Mediation analysis using weighted hierarchical logistic regression analysis studying the effect of AA race on the rate at which interviewees reported that they had received PSA screening in the past 2 years.…”

Section: Discussionmentioning

confidence: 99%

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Patient perspectives of prostate cancer screening vary by race following 2018 guideline changes

Riviere

Kalavacherla

Banegas

et al. 2022

Cancer

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Background:The 2018 US Preventive Services Task Force guidelines recommend individualizing prostate cancer screening in 55-to 69-year-old men. Given the higher incidence of prostate cancer in African American (AA) compared to non-Hispanic White (NHW) men, this study compared reported rates of prostatespecific antigen (PSA) screening hypothesizing that it would not be commensurate with the relative risk between these two groups.Methods: Using the 2020 Behavioral Risk Factor Surveillance System, we identified 43,685 men (40,301 NHW and 3384 AA) interviewed about PSA screening.Results: AA men had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.69-0.93; p = .004) of reporting PSA screening; sequentially correcting for access to care, smoking, and age had minimal effect on this finding, but when correcting for income significantly attenuated this difference (OR, 0.95; 95% CI, 0.81-1.12).Further adding education level eliminated the effect size of AA race entirely with OR, 0.99 (95% CI, 0.84-1.17; p = .91). Further analysis found significant interaction between education and race, with college-educated AA men having 1.42 OR of receiving screening compared to college-educated NHW men.Conclusions: Despite prostate cancer being more common and having higher population-level mortality in AA than NHW men, PSA screening and education patterns do not reflect this increased risk even when adjusting for health access disparities. The authors' findings of significant effect from both income and education suggest that systemic racism is an important factor in the observed difference in PSA screening between AA men and NHW men. Lay summary:� In the United States, prostate cancer is more common in African American men � New guidelines from 2018 encourage physicians to consider risk factors in deciding whether or not to recommend screening, but overall African American men continue to be screened at a lower rate than non-Hispanic White men � This effect disappears when correcting for income and education level, suggesting that several factors including systemic racism, medical mistrust, and selfadvocacy may impact this observed difference 82 -Cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%