AUA 2018: The Association Between Physician Trust and Prostate Specific Antigen Screening: Implications for Shared Decision Making

San Francisco, CA ( Most cancer organizations recommend shared decision making for PSA screening, a process relying on a trusting relationship between patient and physician. The objective of this study was to assess the degree to which an individual’s trust in cancer information from their physician compared to internet based information, impacts the likelihood of receiving PSA-screening. 

This was a cross-sectional study (2011-2014) of the Health Information National Trends Survey (HINTS), a survey of people living in the US. The primary exposure was degree of trust in cancer information from participant’s physician (CIP). The secondary exposure was degree of trust in cancer information from the internet (CII). The primary outcome was patient-reported receipt of PSA screening. The Cochran-Armitage test was used to identify significant trends in the primary outcome, across levels of trust. A multivariable logistic regression model assessed the association between CIP and CII with PSA-screening, adjusted for a priori covariates. 

Among 5069 eligible respondents, 3,606 (71.1%) reported trusting CIP a lot, 1,186 (23.4%) some, 219 (4.3%), a little, and 58 (1.1%) not at all (Figure 1). 2,655 (52.4%) men received PSA-screening. The degree of trust in CIP was strongly associated with the likelihood of receiving PSA-screening: among men who reported a lot of trust, 54.9% underwent screening, 48.6% some trust, 38.4% a little trust, and 27.6% among men not at all trusting their physician (trend p < 0.0001). The degree to which men trusted CII was also associated with having received PSA-screening (p =0.005), albeit with an insignificant trend (p =0.07). After multivariable adjustment, these significant results persisted for degree of CIP trust (a lot vs some OR 0.80, 95%CI 0.66-0.97; 0 vs. a little OR 0.61, 95%CI 0.41-0.90; vs. not at all OR 0.33, 95% CI 0.15-0.73), but not for trust in CII (Table 1).
UroToday AUA2018 Proportion of respondents receiving PSA
UroToday AUA2018 Multivariable logistic regression

The authors concluded that the level of trust an individual has in their physician is strongly associated with undergoing PSA-screening. As rationale implementation of PSA screening requires shared decision making, the level of physician trust has implications for the dissemination of PSA-screening guidelines.

Presented by: Zachary Klaassen, MD, University Health Network/Princess Margaret Cancer Centre
Co-Author: Christopher J.D. Wallis, Hanan Goldberg, Thenappan Chandrasekar, Neil E. Fleshner, Antonio Finelli, Girish S. Kulkarni, Toronto, Canada, Raj Satkunasivam, Houston, TX

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA