From the 2024 HVPA National Conference
Nicholas Spetsieris MD (Long Island Community Hospital), Gayatri Bobba MD, Jonathan London MD, Aleksandr Grzhibek MD, Peter Urazov MD, Ravi Gupta MD, Zubin Tharayil MD
Introduction
Prostate cancer is the second most common cancer in men in the United States and has been estimated to account for 34,700 deaths in 2023. Screening for prostate cancer has been controversial over the years due to the risks of overdiagnosis and treatment. The USPSTF recommends making an individualized decision on prostate cancer screening for men 55 to 69 years of age, after a discussion of the benefits and risks of screening and taking into account patient preferences and values (called shared-decision making, or SDM). Currently, our primary care practice follows the USPSTF guidelines but does not have a standardized prostate cancer screening process. We propose the standardization of prostate cancer screening by utilizing a multidisciplinary approach.
Methods
The records of 50 NYU Langone Medical Associates – Patchogue male patients between 55-69 years of age, with a visit between February-November 2021 for a Complete Physical Examination or Annual Wellness Visit, were reviewed to assess: 1) if a shared decision-making process occurred; 2) did the patient agree to PSA screening; and 3) if PSA was tested. Standardized physician education on prostate cancer screening was implemented by: 1) giving a presentation to all residents/preceptors and 2) providing FAQ sheets to residents. Documentation of the shared decision-making process was standardized by creating a smartphrase in the EMR and using a specific ICD-10 code. All patients included were provided with documentation from the EMR on prostate cancer screening. A data collection sheet was created to track the implementation of a shared decision-making process for each eligible patient encounter, patient agreement/declining of screening and documentation of these in the EMR. A visual reminder was created, in the form of a card, and was placed on every physician workstation. The study period started on March 27, 2023. The primary outcome was to increase the percentage of eligible patients involved in the shared decision-making process for prostate cancer screening. A secondary outcome was to improve EMR documentation of the shared decision process.
Results
A retrospective review of patient charts with the aforementioned criteria revealed that a shared decision-making process was documented in 6/50 patients (12%). Of these, 4 agreed to PSA testing and 2 declined. PSA was tested in 11/50 patients (22%), of whom 7 did not have a documented SDM process. The study began on March 27, 2023 and was completed on March 29, 2024. During the study period, a total of 3688 patients were seen in clinic by residents, of whom 73 (2%) patients were eligible for the study. Shared decision-making process was documented in 48 of the 73 patients (66%). Thirty-six (49%) of the eligible patients agreed to PSA testing. The shared decision-making process was documented as per the study guidelines in patients’ charts. In the course of the study, a consistent rate of 40-45% of SDM process was observed. The intervention was reinforced and SDM process rate increased to 80% after the 2nd intervention.
Conclusion
Implementing a standardized process for prostate cancer screening led to an increased percentage of patients involved in the shared decision-making process and an increase in EMR documentation of the shared decision-making process.