Health Sciences Program Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Health Science

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences – Health Science Department

First Advisor

Steven Hecht

Date of original Performance / Presentation

January 2024

Publication Date / Copyright Date

1-1-2024

Abstract

The 2016 and 2020 Behavioral Risk Factor Surveillance Survey (BRFSS) datasets were explored to examine the impact of the 2018 United States Preventative Services Task Force (USPSTF) prostate cancer screening guideline update for selectively screening men. Examined were men between 40 years to 69 years of age. A conceptual model was tested to determine the links between changes in guidelines, race, shared decision-making, prostate-specific antigen (PSA) test recommendation, and PSA test completion. The change in guidelines was associated with a decreased likelihood of engaging in a shared discussion, receiving a recommendation, and completing a PSA test. However, there was a negative correlation between the USPSTF 2018 guideline changes from the BRFSS 2016 and 2020 datasets that indicate fewer men are being screened for prostate cancer afterward. Health care providers did not follow the USPSTF 2012 guideline to not screen men older than 75 years, yet there were more men being engaged in a shared discussion, provided a recommendation, and completed a PSA test. The 2018 USPSTF guideline change to selectively screen men appears to have resulted in fewer men being provided a recommendation, engaged in shared discussion, and completing a PSA. Race was only associated with shared discussion and receiving a recommendation. These latter two variables also uniquely contributed to obtaining a PSA test. Mediation analyses were suggestive that the effects of changes in guidelines for obtaining a PSA test were almost entirely explained by the influences of shared discussion and recommendations made by the health care provider. Thus, completion of a PSA test is almost fully determined by the shared discussion or recommendation from the health care provider without regard for the race of the man. In all, the findings indicated that the changes made in the prostate cancer screening guidelines were beneficial and supported the shared decision making model.

Disciplines

Medicine and Health Sciences

Keywords

Mens Health; Preventative Health; Prostate Cancer; Prostate Cancer Screening; Prostate Cancer Screening Antigen; PSA Test

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