Do Men Make Informed Decisions about Prostate Cancer Screening? Baseline Results from the “Take the Wheel” Trial

Abstract

Background. The efficacy of prostate cancer (CaP) screening with the prostate-specific antigen (PSA) test is debated. Most medical organizations recommend that men make individual, informed decisions about whether to undergo screening. Informed decision making (IDM) requires adequate knowledge about CaP as well as the risks and benefits of screening; confidence in the ability to participate in decision making at a personally desired level (decision self-efficacy); and decision making that reflects one’s values and preferences (decisional consistency). Methods. Baseline data from a randomized trial in 12 worksites were analyzed. Men aged 45+ ( n = 812) completed surveys documenting screening history, screening preferences and decisions, CaP knowledge, decision self-efficacy, and decisional consistency. Psychosocial and demographic correlates of IDM were also assessed. Results. Approximately half of the sample had a prior PSA test, although only 35% reported having made an explicit screening decision. Across the sample, CaP knowledge was low (mean = 56%), although decision self-efficacy was high (mean = 78%), and the majority of men (81%) made decisions consistent with their stated values. Compared with those who were undecided, men who made an explicit screening decision had significantly higher levels of knowledge, greater decisional self-efficacy, and were more consistent in terms of making a decision in alignment with their values. They tended to be white, have high levels of income and education, and had discussed screening with their health care provider. Conclusions. Many men undergo CaP screening without being fully informed about the decision. These findings support the need for interventions aimed at improving IDM about screening, particularly among men of color, those with lower levels of income and education, and those who have not discussed screening with their provider.