Informed Decision Making:
How to Make a Personal Health Care Choice

The Public Health Problem

In 2004*, 189,075 new cases of prostate cancer were diagnosed and 29,002 men died of the disease, according to the United States Cancer Statistics: 1999–2004 Incidence and Mortality report. Currently, there is no scientific consensus on effective strategies to reduce the risk of prostate cancer. Additionally, there is no agreement on the effectiveness of screening or that the potential benefits outweigh the risks. Therefore, public health agencies face significant challenges in determining what actions to take to address prostate cancer.

Given the uncertainty about the benefit of screening, the principal public health approach is to support informed decision making about screening. Public health agencies and related organizations are attempting to provide men with current information about the benefits and risks of prostate cancer screening so that each man can make his own decision, given his own values and preferences.

U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2007.

*The most recent year for which statistics are currently available.

CDC’s Response

Shared decision making is a process carried out between a patient and his health care professional in the clinical setting where both parties share information and the patient understands the nature and risks of prostate cancer; the risks, benefits and alternatives to screening; participates in decision making at a level he desires; and makes a decision consistent with his preferences and values, or defers the decision to a later time. more... Informed decision making occurs when an individual understands the nature and risks of prostate cancer; the risks, benefits, and alternatives to screening; participates in decision making at a level he desires; and makes a decision consistent with his preferences and values, or defers the decision to a later time. more...

CDC and other federal agencies follow the prostate cancer screening guidelines set forth by the U.S. Preventive Services Task Force (USPSTF), led by the Agency for Healthcare Research and Quality (AHRQ). CDC supports the assessment of and follows the recommendation set forth by the U.S. Preventive Services Task Force.

CDC has developed a portfolio of educational materials about prostate cancer screening, which are designed to promote discussion between patients and physicians and to help men aged 50 years or older make informed decisions about prostate cancer screening. These materials include

Prostate Cancer Screening: A Decision Guide for African Americans
This informed decision making guide targets African-American men. At all ages, African-American men die of prostate cancer more often than other men do. The reasons for the variation among groups are unknown, making it critical that African-American men know the facts about prostate cancer and the available screening tests.

La Detección del Cáncer de Próstata: Una Guía para Hispanos en los Estados Unidos (PDF-512KB)
This 24-page booklet, written in Spanish, provides basic information and encourages Hispanic men to decide whether screening is the right choice for them.

Spotlight on Science

Why do men choose one treatment over another?

Zeliadt SB, Ramsey SD, Penson DF, Hall IJ, Ekwueme DU, Stroud L, Lee JW. Why do men choose one treatment over another?: a review of patient decision making for localized prostate cancer. Cancer 2006;106(9):1865–1874.

Prostate-specific antigen test use reported in the 2000 National Health Interview Survey

In 2000, the National Health Interview Survey (NHIS) collected information about prostate-specific antigen (PSA) test use in a representative sample of U.S. men. This study examined PSA test use in subgroups of men, defined by personal and social characteristics. Among men aged 50 years and older with no history of prostate cancer, 56.8% reported ever having had a PSA test, 34.1% reported having had a PSA test during the previous year, and 30% reported having had three or more tests during the previous 5 years. Screening was greater among men aged 60–70 years, those with greater access to care, and those practicing other preventive behaviors.

Among men in their 40s, use tended to be higher among African-American men. The prevalence and patterns of PSA screening suggest that it is used like other cancer screening tests among about a third of U.S. men. Because of the lack of scientific consensus on whether prostate cancer screening is beneficial, more information is needed on how knowledgeable both patients and practitioners are about the potential benefits and harms of screening and how prostate cancer screening decisions are made.

Ross LE, Coates RC, Breen N, Uhler RJ, Potosky AL, Blackman D. Prostate-specific antigen test use reported in the 2000 National Health Interview Survey. Preventive Medicine 2004;38(6):732–744.

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