Purpose: To identify prevalence of informed consent (IC) among veteran males who had prostate-specific antigen (PSA) testing.
Background: Prostate cancer is the most commonly diagnosed invasive cancer in the U.S., and PSA testing is widespread. Informed decision making is critical given variation in screening guidelines.
Methods: The 2012 Behavioral Risk Factor Surveillance System was used for this study. The analytic sample included 11,589 male veterans aged 55 to 69 years from all states, Guam, and Puerto Rico who had PSA testing within the past 2 years and valid IC data. The study excluded 473 (3.9%) participants due to invalid IC data. Informed consent was defined as having discussed both advantages and disadvantages of PSA testing with a health care professional. Participants who discussed only advantages, only disadvantages, or neither were considered to have received inadequate IC.
Data Analysis: A chi-square test and survey-adjusted population weighted-multivariable logistic regression analysis were conducted, which were adjusted for age, marital status, smoking status, income, education level, general health status, and veterans benefits administration region.
Results: Among the sampled veterans, 42.3% of participants received IC, discussing both advantages and disadvantages of PSA testing. Nearly 58% received inadequate IC, discussing only advantages, only disadvantages, or neither. There was no statistically significant difference between IC among veterans and the general population (P = .08, a = 0.05). Of the participants who received inadequate IC, 50.7% discussed only advantages of PSA testing, 0.5% discussed only disadvantages, and 6.6% discussed neither. Given the adjusted model, there was no statistically significant difference in IC completion between geographic regions.
Conclusions: Only 42.3% of veterans reported completing IC for PSA testing with a health professional. Discussion of only advantages (50.7%) was more likely than discussion of only disadvantages (0.5%). Among veterans, completion of IC was similar between regions. Prevalence of IC among veterans was similar to prevalence among the general population. Given the importance of informed decision-making, health professionals should focus on regularly engaging patients in informed decision making prior to PSA testing
