Prostate cancer (CaP) is a prevalent and serious disease with no known methods of primary prevention. African American (AA) men are disproportionately affected by CaP;they are 60% more likely to be diagnosed and nearly 2.5 times more likely to die from the disease than White men. Screening with prostate specific antigen (PSA) is the main method of early detection, although it remains of unproven benefit. Major medical organizations debate the potential benefits versus harms of prostate cancer screening (PCS), but they all emphasize educating men about the potential limitations, risks and benefits of PCS, and helping them to make individualized decisions with their medical providers ("shared decision-making," or SDM). Nonetheless, this is not the norm in clinical practice, especially for AA men. Numerous decision aids (DAs) have been developed to help men make informed decisions regarding PCS. Unlike most prior PCS studies, however, we have developed a culturally relevant DA;make use of low cost, modern technologies to deliver the multi-media, individually tailored DA;gather data from patients and providers to study the dyad;and assess the potential for integration of PCSPrep into clinical practice. We address these research gaps by testing the Prostate Cancer Screening Preparation (PCSPrep) -- a tailored, interactive, Web-based, and culturally relevant DA -- on outcomes related to SDM among AA men. Primary care providers (PCP) affiliated with Beth Israel Deaconess Medical Center will be recruited. From each PCP, we will recruit and enroll 10 AA men ages 45-70 (N=100). Study participants will complete a pre-test, PCSPrep, and post-test immediately prior to a routine medical visit. PCS discussions between patient and provider will be audio-taped and both patients and providers will complete assessments immediately after the visit.
Specific aims are to estimate the impact of PCSPrep on: (1) patients'PCS knowledge, decision self-efficacy, and decisional consistency;(2) providers'perceptions of patient engagement, concordance between provider/patient ratings of SDM;and (3) feasibility and acceptability of integrating PCSPrep into primary care practice. The ultimate goal is to reduce disparities in access to high quality information about PCS and to empower AA men to be active participants in their care. Results will not only inform decision-making for PCS, but can inform the development of interventions for other conditions or procedures that call for SDM.
This study is significant because it is expected to lead to the expansion of eHealth technology to assist men making complex medical decisions with their providers about a screening test for which there is uncertain efficacy. As a result of this project we will have a culturally relevant, multi-media, individually tailored DA that will prepare men to take part in SDM about PCS. Moreover, we will have preliminary information about the impact of provider discussions on men's PCS preferences and the extent to which patients and providers view the same clinical encounter differently. This will ultimately lead to multi-level interventions directed at patients, providers and health systems to improve patient-centered decision-making.