Prostate-specific antigen (PSA) screening for the early detection of prostate cancer has been widely adopted in the U.S. among elderly men, including those with limited life expectancy. Such screening is grounded in pervasive beliefs that screening is always the safest course of action, despite the uncertain benefit of PSA screening. Therefore, this proposal makes innovative use of VA and Medicare claims-based data and electronic health records to determine factors associated with PSA screening and the downstream consequences following screening in elderly men across a spectrum of advancing age and comorbid illness. This includes men with favorable 10-year life expectancy for whom several guidelines recommend screening, and men with limited life expectancy for whom screening is unlikely to be beneficial. Such data are fundamental for informed PSA screening decisions among the many elderly men who are considering screening and for the development of quality measures that reward clinicians for avoiding excessive testing. This application proposes a cohort study of 826,908 men aged 65 years and older who were seen at 104 Veterans Affairs (VA) facilities during 2002 and 2003, without a history of prostate cancer, elevated PSA, or prostate cancer symptoms. VA data and Medicare claims will be used to measure the performance of PSA testing during 2003 as well as the health-system, provider, and patient-level determinants of screening and the downstream consequences following screening. Subsets of men will also be selected to obtain richer clinical detail from electronic health records about additional determinants and consequences of screening.
The aims of this project are 1) to determine the health-system, provider, and patient factors associated with PSA screening in elderly men across a spectrum of advancing age and comorbid illness;2) to quantify the real world downstream consequences (e.g., PSA testing, prostate biopsies, cancer diagnosis, treatment, and complications) during the 3 years following PSA screening in elderly men across a spectrum of advancing age and comorbid illness;and 3) to identify health-system, provider, and patient factors associated with these downstream consequences. Factors associated with PSA screening and initiating each step in the cascade of downstream consequences will be identified according to life expectancy to determine where targeted interventions are needed to discourage excessive testing in elderly men.
This study will have unique public health importance because it will be the largest real world study of how PSA screening is being targeted among elderly men according to life expectancy and the downstream consequences associated with these screening decisions. The findings of this study are critical to improving PSA screening decisions in elderly men as well as to improving national screening guidelines, decision aids, and quality measures in this area.
|Tang, Victoria L; Shi, Ying; Fung, Kathy et al. (2016) Clinician Factors Associated With Prostate-Specific Antigen Screening in Older Veterans With Limited Life Expectancy. JAMA Intern Med 176:654-61|
|Hoffman, Richard M; Shi, Ying; Freedland, Stephen J et al. (2015) Treatment patterns for older veterans with localized prostate cancer. Cancer Epidemiol 39:769-77|
|Lewis, Carmen L; Adams, Jared; Tai-Seale, Ming et al. (2015) A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings. J Gen Intern Med 30:810-6|
|Uhlig, Katrin; Leff, Bruce; Kent, David et al. (2014) A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity. J Gen Intern Med 29:670-9|
|Shi, Ying; Fung, Kathy Z; Freedland, Stephen J et al. (2014) Statin medications are associated with a lower probability of having an abnormal screening prostate-specific antigen result. Urology 84:1058-65|
|Walter, Louise C; Schonberg, Mara A (2014) Screening mammography in older women: a review. JAMA 311:1336-47|
|Espaldon, Roxanne; Kirby, Katharine A; Fung, Kathy Z et al. (2014) Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold. Urology 83:599-605|
|Lee, Sei J; Leipzig, Rosanne M; Walter, Louise C (2013) Incorporating lag time to benefit into prevention decisions for older adults. JAMA 310:2609-10|
|Schonberg, Mara A; Walter, Louise C (2013) Talking about stopping cancer screening-not so easy. JAMA Intern Med 173:532-3|
|Eckstrom, Elizabeth; Feeny, David H; Walter, Louise C et al. (2013) Individualizing cancer screening in older adults: a narrative review and framework for future research. J Gen Intern Med 28:292-8|
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