Link Between Health Literacy and PSA Screening Rates Interview with:
David-Dan Nguyen, MPH
Research Fellow | Center for Surgery and Public Health
Brigham and Women’s Hospital
Medical Student | McGill University What is the background for this study?

Response: In 2017, the US Preventive Services Task Force updated its recommendation for PSA screening for prostate cancer from a grade D to a grade C for men aged 55 to 69 years. This updated recommendation endorsed shared decision making and harmonizes with the guidelines of the American Urological Association and the American Cancer Society which also recommend shared decision making for PSA screening.

Shared decision making is a meaningful dialogue between the physician and the patient that namely includes a review of risks and expected outcomes of screening as well as the patient’s preferences and values. Understandably, the patient’s ability to critically assess the medical information provided (i.e. their health literacy) likely influences this process.

We sought to characterize the effect of health literacy on shared decision making for PSA screening. We used data from 2016 when PSA screening for prostate cancer was not recommended by the US Preventive Services Task Force — in other words, we also sought to understand how health literacy impacted screening rates in the context of countervailing guidelines on PSA screening. What are the main findings?

Response:With a weighted sample of over 12 million patients, we found that patients with the highest health literacy had the highest screening rate despite the US Preventive Services Task Force recommendation against PSA screening (this recommendation was changed in 2017). We also noted a significant interaction between health literacy and shared decision making — with higher health literacy reducing the screening-promoting effect of shared decision making. What should readers take away from your report?

Response: Readers should takeaway that there is a dynamic interplay between health literacy and shared decision making in the context of PSA screening for prostate cancer. Our findings have implications for the creation and promulgation of shared decision making guidelines for cancer screening, especially when considering low health literacy patients. What recommendations do you have for future research as a result of this study?

Response: Future research in this space should seek to prospectively examine the impact of health literacy and shared decision making on cancer screening disparities, quality, and outcomes. More importantly, research leading to tools that can help optimize conversations on cancer screening are needed.


Nguyen, D‐D,  Trinh, Q‐D,  Cole, AP,  Kilbridge, KL,  Mahal, BA,  Hayn, M,  Hansen, M,  Han, PKJ,  Sammon, JD. Impact of health literacy on shared decision making for prostate‐specific antigen screening in the United States. Cancer.  2020.

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Last Updated on November 18, 2020 by Marie Benz MD FAAD