African American and some Native American men experience a greater burden of prostate cancer in the United States. Surgery and radiation therapy are effective treatments, but each has different quality of life implications for men and their partners. These treatments, although potentially life-saving impose their own burden related to treatment side effects. Some men may benefit from a monitoring approach called "active surveillance" if they have early, slow-growing prostate cancer. Making the right treatment choice depends of men being given all appropriate options and making sure they have a high quality conversation with their specialty provider. Minority men in particular are not always given the evidence they need to make the right choice for them, and doctors and healthcare systems may not always pay attention to what is important to them. Tools called "decision aids" can improve knowledge and may reduce the burden associated with prostate cancer treatment in minority men. These tools inform men about their disease severity, treatment options, and the quality of life implications of each treatment option. They can be delivered in clinical discussion with specialists or prior to a visit with a specialist. However, decision aids are not routinely usd in specialty practice for prostate cancer. A tablet-based tool we have developed, Prostate Choice, helps men tailor their choice based on their disease risk, life expectancy, and current sexual and urinary function. It can be used in the clinical conversation. Another tool, Knowing Your Options, is a website with comprehensive educational materials that is designed for use prior to visits with specialists. We want to study two kinds of decision aids - ones delivered in te visit with a specialist and one delivered before seeing a specialist as well as the combination of the two decision aids-to see if we can put patients in the best position possible to make the treatment choice that is right for them. We think these tools will reduce known disparities in patient knowledge and may improve the burden of men's symptoms a year after prostate cancer diagnosis. We propose an experiment that delivers the two types of decision aids compared to usual care by assigning 32 specialty practices to get different types of decision aids or usual care. To test the experiment we will enroll 310 men (120 white, 120 African American, 70 American Indian/Alaska Native). From this experiment we will see whether one or the other of the two proposed decision aids or the combination of the two improves men's knowledge most compared to usual care. We will be able to determine whether those effects are the same or different for men from different racial backgrounds and education levels. By testing these tools we will determine whether they can reduce known disparities in patient knowledge and quality of life in minority men.
Among the more than 200,000 men diagnosed with prostate cancer each year, minority men face significant disparities in disease severity, knowledge about treatment options and implications, survival and symptom burden. Decision aids delivered within or prior to specialty visits or the combination might help reduce disparities by improving patient knowledge, and allowing them to make a treatment choice that is appropriate and that fits with their priorities related to sexual and urinary function. This proposal will test in-visit, out-of-vsit and combined in-visit/out-of-visit decision aids for African-American and American Indian/Alaska Native men for initial prostate cancer treatment decisions in a cancer cooperative group.