Shared Decision-Making Process and PSA Testing Among Black Men

Little is known about the shared decision-making (SDM) process regarding prostate-specific antigen (PSA) testing between Black men and their healthcare providers. Despite the USPSTF recommendation against PSA testing, prior studies report that this population intends to continue receiving the test. This study applied the prescriptive decision theory as the framework and used binary logistic regression to determine a) patient characteristics as predictors of SDM, and b) SDM as a predictor of receiving a PSA test among U.S. Black men (N=167, 40-70 years old). Analysis revealed that participants are not actively involved in a complete and informed SDM process before making a PSA testing decision. A majority (88%) reported that providers recommended PSA testing and 80% were tested. However, two key elements of SDM were often absent: 1) participating in collaborative decisions with providers (29%), and 2) being informed of specific test-related risks. For example, participants were not informed that test is not always accurate (60%), some prostate cancers are slow growing and need no treatment (65%), and treatment can have serious side effects (51%). Older participants (50-70) were more likely to be informed of risks than younger participants (40-49) (p=.02, OR 2.44,  1.18-5.04). Only two SDM components were predictors of PSA testing: 1) presented with option to choose test (p=.01, OR 3.20, 1.39-7.37) and 2) informed of risks in general rather than specific testing risks (p=.02, OR 2.75, 1.20-6.33). Findings suggest that providers are recommending PSA testing to Black men however Black men are not being thoroughly informed nor participating fully in the SDM process.