Physician Attitudes and Self-reported Practices Toward Prostate Cancer Screening in Black and White Men

Abstract

Background and Objectives: Updated 2018 prostate cancer screening guidelines recommend informed decision-making discussions, which should include education on prostate cancer’s disproportionate impact on Black men. It is unknown whether academic family physicians follow these guidelines. Methods: Family physicians were surveyed as part of the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey. We used χ2 to compare physicians’ knowledge and screening practices stratified by physician age, gender, and percentage of Black patients in patient panel. We calculated logistic regressions predicting shared decision-making conversations, barriers to shared decision-making, inclusion of race in prostate cancer screening approach, and prostate-specific antigen (PSA) testing adjusted for physician age, gender, and percentage of Black patients. Results: Physicians reported engaging in shared decision-making for prostate cancer screening in half of eligible men. Only 29.2% of physicians reported routinely informing Black men of their increased prostate cancer risk. In logistic regressions, physician gender (female) and fewer Black patients in panel (<25%) were associated with lower frequency of shared decision-making with Black patients. Physician age (<40 years) was associated with not discussing race during screening discussions (OR 2.24, 95% CI 1.55–3.23). Conclusions: Most academic family physicians do not appropriately inform Black men of increased prostate cancer risk, with younger physicians less likely to discuss race than older physicians. Female physicians, and physicians who see fewer Black patients, are less likely to have shared decision-making conversations with Black patients. This suggests educational efforts for these groups are needed to address health disparities in prostate cancer.

Barriers and facilitators of shared decision-making in prostate cancer screening in primary care: A systematic review

“…After the title and abstract screen, we retrieved the full-text articles of 18 potentially eligible studies. Of these, we included 13 in our systematic review ( O’dell et al, 1999 , McFall, 2006 , van Vugt et al, 2010 , Avery et al, 2012 , Allen et al, 2018 , Shungu and Sterba, 2021 , Dunn et al, 2001 , Guerra et al, 2007 , Volk et al, 2013 , Shungu et al, 2022 , Warlick et al, 2017 , Denberg et al, 2009 , Ilic et al, 2018a , Ilic et al, 2018b ). Fig.…”

“…All studies were published between 1999 and 2022. Most were published in or after 2010 (N = 8; 62 %) ( van Vugt et al, 2010 , Avery et al, 2012 , Allen et al, 2018 , Shungu and Sterba, 2021 , Volk et al, 2013 , Shungu et al, 2022 , Warlick et al, 2017 ; Ilic et al, 2018). Ten studies (77 %) were set in the USA ( O’dell et al, 1999 , McFall, 2006 , Allen et al, 2018 , Shungu and Sterba, 2021 , Dunn et al, 2001 , Guerra et al, 2007 , Volk et al, 2013 , Shungu et al, 2022 , Warlick et al, 2017 , Denberg et al, 2009 ).…”

“…Most were published in or after 2010 (N = 8; 62 %) ( van Vugt et al, 2010 , Avery et al, 2012 , Allen et al, 2018 , Shungu and Sterba, 2021 , Volk et al, 2013 , Shungu et al, 2022 , Warlick et al, 2017 ; Ilic et al, 2018). Ten studies (77 %) were set in the USA ( O’dell et al, 1999 , McFall, 2006 , Allen et al, 2018 , Shungu and Sterba, 2021 , Dunn et al, 2001 , Guerra et al, 2007 , Volk et al, 2013 , Shungu et al, 2022 , Warlick et al, 2017 , Denberg et al, 2009 ). Only two (15 %) took place in European counties (the Netherlands ( van Vugt et al, 2010 )) and the UK ( Avery et al, 2012 )) and one took place in Australia (Ilic et al, 2018) ( Table 1 ).…”

“… Questionnaire-based quantitative study Physician members of the American Academy of Family Physicians National Research Network Physicians in training 243 physicians answered the questionnaire. Shungu et al, 2022 USA (South Carolina, Georgia) To describe how family physicians approach prostate cancer screening in general. To identify demographic variables associated with engaging patients in SDM discussions Questionnaire-based quantitative study Family physician members of the Council of Academic Family Medicine (CAFM) Program directors, administrative directors and department heads 1192 participants.…”

Late hepatitis C virus diagnosis among patients with newly diagnosed hepatocellular carcinoma: a case–control study

“…One plausible explanation may be the influence of patient-physician gender concordance on screening behaviors. For example, people who were care by male physician would yield a higher prostate cancer screening rate [ 53 ]. Female physicians were more likely to recommend human papillomavirus (HPV) vaccine [ 54 ] and mammography screening [ 55 ].…”