The Problem
2012, the US Preventive Services Task Force (USPSTF) issued the lowest recommendation grade (grade D) to PSA screening stating that the risks outweigh the benefits due to over- diagnosis and overtreatment. However, the USPSTF recommendation did not account for populations at high-risk for prostate cancer such as African-American men and those with a positive family history. In aggregate, these disparate recommendations led to increased confusion and variation in primary care provider practice around prostate cancer screening.
Our Solution
In response to these challenges, the Duke Cancer Institute’s Prostate Cancer Working Group designed a novel evidence-based PSA screening algorithm. This algorithm helps to standardize Duke’s approach to prostate cancer screening and evaluation, and was tailored to the needs of the North Carolina male population that includes more than 20-30% African American men. However, it was still necessary to inform and educate primary care physicians (PCPs) of the new algorithm and to facilitate its seamless implementation and utilization within the electronic health record.
Impact
Inclusion of the novel PSA screening algorithm into the EHR in a manner that prompts PCPs to consider PSA screening when willing patients present with certain parameters (age, race etc). The EHR also includes a link to the full algorithm that PCPs can use in real-time during the visit. Educational presentations at numerous Duke-affiliated PCP clinics. During these educational sessions, PCPs received information on the rationale behind the new PSA algorithm, who the men are who will benefit most, and how it should be implemented.
