The study examines health literacy and shared decision making in prostate cancer screening

New research examines the dynamics between men’s health literacy, their discussions with their doctors, and their decisions about whether to get tested for prostate specific antigen (PSA), a potential marker of prostate cancer. The results were soon published online in Cancer, a peer-reviewed journal of the American Cancer Society (ACS).

There is controversy over PSA testing for prostate cancer because it can lead to overdiagnosis and subsequent overtreatment. In 2012, the guidelines recommended against PSA screening for all men, but the most recent guidelines from 2017 say that for men aged 55-69, doctors and patients should have meaningful discussions about the benefits and advantages. disadvantages of PSA screening in order to make choices based on a shared decision-making process.

This approach depends on the ability of both clinicians to explain relatively complex clinical concepts clearly and accurately and to involve patients in the process, as well as the ability of patients to understand the information provided. In this regard, health literacy, or the degree to which individuals have the ability to understand health information and services to make appropriate health decisions, is important.

To better understand the effect of health literacy and shared decision-making on patients’ likelihood of PSA screening, the researchers looked at 2016 data from the Behavioral Risk Factor Surveillance System, an annual random sample health survey. of US adults. The analysis included information representing over 12 million men aged 50 and over who reported last year’s PSA screening status.

Greater health literacy was associated with higher PSA screening rates, a surprising finding given the 2012 guideline recommendation against screening. This finding suggests that men with higher health literacy may require PSA testing despite knowledge of the recommendations, or that doctors may be more likely to offer PSA screening to patients with higher health literacy than others. patients.

Researchers also identified a dynamic interplay between health literacy and shared decision making. Specifically, in the presence of shared decision-making, patients with higher health literacy were less likely to be screened for ASF than patients with low health literacy.

“This discovery should inform the creation and promulgation of shared guidelines and decision-making interventions, particularly when considering patients with low health literacy,” said lead author David-Dan Nguyen, MPH, researcher at the Center for Surgery and Public Health (a joint initiative of Brigham and Women’s Hospital and Harvard TH Chan School of Public Health), under the supervision of Dr. Jesse Sammon, DO, assistant professor at Tufts University School of Medicine. Nguyen noted that doctors may also need guidance in assessing patients’ health literacy. “Providers have consistently overestimated patient health literacy, and this poor accuracy may diminish providers’ ability to successfully personalize patient communication and engage them in shared decision making, especially for patients with the lowest literacy levels. health care, “he said.

An accompanying editorial notes that the study provides important insights into the relationship between health literacy, shared decision-making, and ASF screening and notes that the results offer less insight into the character of this dynamic in the general population. “Further prospective investigations are needed on how best to educate and empower vulnerable populations with lower health literacy to make informed decisions in order to design effective interventions to improve ASF screening in higher-risk populations,” the authors wrote.