# Building a shared decision making implementation strategy for the emerging paradigm of precision cancer screening

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2024 · —

## Abstract

PROJECT SUMMARY
Background: Prostate cancer screening with prostate-specific antigen (PSA) testing only modestly reduces
the number of deaths at the expense of increasing the morbidity associated with overdiagnosed cases and
unnecessary treatment. As a result, clinical guidelines recommend against universal PSA screening for men
but do call for shared decision making (SDM). SDM involves discussing the benefits and harms of interventions
and incorporating patient preferences into decisions. Effective SDM requires healthcare systems-level support,
promotion of SDM skills for practitioners and patients, as well as context-specific knowledge for all involved.
Without proper planning for and support for providers to implement SDM and patients to participate, such
guideline-recommended discussions cannot be expected. Meanwhile, the next frontier in cancer screening is a
new paradigm of precision screening, in which an individual’s genetic make-up may be used to stratify their
level of future cancer risk and inform whether, how early, and how often they should be screened. Polygenic
risk scores (PRS) are composite risk estimates derived from large, population-based genome-wide association
studies. The goal of incorporating PRS into population screening is to reduce the harms of overdiagnosis and
unnecessary treatment for low-risk individuals while preserving screening benefits for those at highest risk.
Significance: Both precision screening and SDM are major pillars of the new White House Cancer Moonshot
v2.0. PRS-informed prostate cancer screening is likely to be the first of these precision screenings within the
Veterans’ Health Administration (VHA). Our project is also clearly aligned with VHA’s patient-centered learning
initiative to turn VHA into a health literate care organization.
Innovation and Impact: This clinical innovation will have direct impact on primary care, where cancer
screening decisions are made. The limited genetic counseling workforce is not sufficient to offload all
conversations about PRS from patient-aligned care teams (PACTs) in which primary care providers (PCPs)
work. The potential effect of PRS-guided screening on equity is also a concern. Current guidelines consider
Black race risk factor that might favor PSA screening, as Black men are twice as likely to die of prostate cancer
than white men. Any new screening paradigm must consider existing disparities and a historical context of
racial discrimination and mistrust for a prostate cancer PRS is to be accepted among racially diverse patients.
Specific Aims: To proactively address VHA’s needs in implementing a prostate cancer PRS using SDM into
primary care, we propose the following aims: 1) Qualitatively describe Veterans’ decision support needs to
discuss PRS and use them in SDM about prostate cancer screening; 2) Qualitatively describe and
quantitatively determine the perceived competency, perceived barriers, and informational and support needs
for implementing SDM aroun...

## Key facts

- **NIH application ID:** 10748490
- **Project number:** 1I01HX003627-01A2
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Marla L. Clayman
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2023-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10748490

## Citation

> US National Institutes of Health, RePORTER application 10748490, Building a shared decision making implementation strategy for the emerging paradigm of precision cancer screening (1I01HX003627-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10748490. Licensed CC0.

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