Racial and Ethnic Variation of Shared Decision Making in Prostate Cancer Screening Following Updated 2018 Screening Guidelines
Abstract
Introduction and Objective. Prostate cancer screening guidelines have evolved over the last two decades. In 2018, the United States Preventive Services Task Force (USPSTF) promoted shared decision making (SDM) between healthcare provider and patient for men aged 55 to 69. This study aimed to analyze rates of Prostate Specific Antigen (PSA) testing across racial and ethnic groups following these guidelines changes. Methods. We performed a secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) database from 2020 and 2021 to assess men aged 55 or older without a history of prostate cancer. We defined four race-ethnicity groups: non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, and Other. The primary outcome was self-reported SDM in PSA testing, defined as either having discussed the advantages or disadvantages of PSA testing with their healthcare provider, from the BRFSS survey. We assessed associations in demographic variables using Chi-Squared analysis. We then performed logistic regression to determine odds ratios for engaging in SDM and adjusted for age, marital status, smoking history, socioeconomic factors, and healthcare access. Results. In the age 55 to 69 group, NHB men had the highest percentage of SDM (n=1,090, 30%), while Other ethnicities had the lowest percentage (n=636, 19.3%) (P=0.0018). With NHW as referent, the maximally adjusted odds ratio (OR) for SDM was 1.40 (95% CI = 1.18-1.67) for NHB, 0.93 (95% CI= 0.70-1.23) for Hispanics, and 0.63 (95% CI= 0.45-0.89) for Other ethnicities. Conclusions-Implications. Non-Hispanic Black adult men had increased odds of having engaged in SDM with medical providers regarding PSA testing when compared to NHW. These findings run contrary to historical data. This may be attributed to nationwide initiatives aimed at improving screening practices for this specific subgroup, which faces an elevated risk of prostate cancer.
Keywords
cancer screen, prostate specific-antigen, prostate cancer, social determinants of health
Presentation Type
Poster Presentation
Racial and Ethnic Variation of Shared Decision Making in Prostate Cancer Screening Following Updated 2018 Screening Guidelines
Introduction and Objective. Prostate cancer screening guidelines have evolved over the last two decades. In 2018, the United States Preventive Services Task Force (USPSTF) promoted shared decision making (SDM) between healthcare provider and patient for men aged 55 to 69. This study aimed to analyze rates of Prostate Specific Antigen (PSA) testing across racial and ethnic groups following these guidelines changes. Methods. We performed a secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) database from 2020 and 2021 to assess men aged 55 or older without a history of prostate cancer. We defined four race-ethnicity groups: non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, and Other. The primary outcome was self-reported SDM in PSA testing, defined as either having discussed the advantages or disadvantages of PSA testing with their healthcare provider, from the BRFSS survey. We assessed associations in demographic variables using Chi-Squared analysis. We then performed logistic regression to determine odds ratios for engaging in SDM and adjusted for age, marital status, smoking history, socioeconomic factors, and healthcare access. Results. In the age 55 to 69 group, NHB men had the highest percentage of SDM (n=1,090, 30%), while Other ethnicities had the lowest percentage (n=636, 19.3%) (P=0.0018). With NHW as referent, the maximally adjusted odds ratio (OR) for SDM was 1.40 (95% CI = 1.18-1.67) for NHB, 0.93 (95% CI= 0.70-1.23) for Hispanics, and 0.63 (95% CI= 0.45-0.89) for Other ethnicities. Conclusions-Implications. Non-Hispanic Black adult men had increased odds of having engaged in SDM with medical providers regarding PSA testing when compared to NHW. These findings run contrary to historical data. This may be attributed to nationwide initiatives aimed at improving screening practices for this specific subgroup, which faces an elevated risk of prostate cancer.