Prostate cancer is the most commonly diagnosed noncutaneous cancer in United States men and the second leading cause of cancer death. It is estimated that 186,320 men will be diagnosed with prostate cancer in 2008 and 28,660 men will die of it. Prostate cancer disproportionately affects African American men, who have a 1.7 fold greater incidence and a 2.4 fold greater mortality than white men. As a result, prostate cancer is an important source of health disparities. We will use the Ottawa Decision Support Framework (ODSF) from the field of shared decision making to examine prostate cancer health literacy among African American men from two clinics caring for large underserved populations. Values clarification and risk communication are central to the process of prostate cancer screening decisions because screening has not been shown to decrease cancer mortality but the side effects of treatment are prevalent and long term. It is critical for physicians and patients to be able to accurately discuss the impotence, incontinence, and bowel symptoms that often result from treatment, so patients can decide whether to be screened for prostate cancer. In preliminary studies, we reviewed patient education materials to identify six specific domains of prostate cancer health literacy. These domains include the skills that patients need to learn new information and the knowledge that patients are assumed to have at baseline. In preliminary structured interviews among African American men in two low-income clinics, we showed that many patients did not have the health literacy skills or knowledge that consumers are assumed to possess. Consequently, we hypothesize that patients are unlikely to learn enough about prostate cancer from standard materials provided by the Centers for Disease Control (CDC) and the National Cancer Institute (NCI) to participate in shared decision making as currently recommended by most health agencies. We have established a collaboration with the NCI's Cancer Information Service, Howard University, and the Tug River Health Association in rural West Virginia to explore this hypothesis. Using structured interviews, we will characterize understanding of CDC and NCI prostate cancer decision guides with a focus on numerical and graphical risk communication among men with poor reading skills. We will link our study to other work in the field using recently developed numeracy scales to relate mathematical skills and reading skills to how patients understand the uncertainties of the screening decision. We will use qualitative methods and conceptual metaphor to explore ways to improve communication and shared decisions for African American men with low literacy skills. Results will be used to revise prostate cancer education materials to be more accessible to men with low literacy skills.
Prostate cancer mortality is an important source of health disparities among African American men. In preliminary studies, we have identified barriers to prostate cancer health literacy among African American men recruited from two rural, low-income clinics. We will use qualitative methods to identify techniques to overcome these barriers and compare any differences between rural and urban African American men.