Effect of shared decision making on racial and ethnic disparity in prostate cancer screening: Results from a national behavioral survey

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Conference Proceeding

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Eur Urol


Introduction & Objectives: The 2018 United States Preventive Services Task Force recommendations endorsed shared decision making (SDM) for men aged 55-69 and encouraged consideration of patient race and ethnicity for prostate specific antigen (PSA) screening. We sought to assess whether SDM modified the effect of race and ethnicity on the likelihood of PSA screening.

Materials & Methods: A cross-sectional analysis of men aged between 55 and 69 who responded to the PSA screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey was performed. Men without a diagnosis of prostate cancer who self-reported a PSA test in the previous 12 months as part of a routine examination were considered screened. SDM was defined based upon whether the respondents had been informed by a physician about the benefits and harms of PSA screening. The main predictors were patient race and the interaction between race/ethnicity and SDM. Complex weighted sample multivariable logistic regression models were fitted to test the associations.

Results: Out of a weighted sample of 26.8 million men eligible for PSA screening, 25.7% (6.9 million men) reported PSA screening. In adjusted analysis, SDM was a significant predictor of PSA screening (aOR:2.65, 95%CIs:2.36-2.98, p<0.001). The interaction between race/ethnicity and SDM on the receipt of PSA screening was significant (pint=0.001), meaning that the effect of race on the odds of PSA screening varied based on SDM. Among those who did not report SDM, both non-Hispanic Black (OR:0.77, 95%CIs: 0.61–0.97, p=0.026) and Hispanic (OR:0.51, 95%CIs: 0.39–0.68, p<0.001) men were significantly less likely to undergo PSA screening than non-Hispanic white men. On the contrary, among respondents who reported SDM, we found no race-based differences in the odds of PSA screening (Figure 1).

Conclusions: SDM was a significant predictor of PSA screening use and has a direct impact on reducing disparities in PSA screening among racial and ethnic groups.



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