Research Project 3: Fostering informed decision-making on prostate cancer among Clinicians and African American men Project Summary/Abstract Despite years of aggressive prostate cancer (PrCa) screening practices and declines in mortality in the U.S., African American men still have the highest PrCa incidence and mortality rates. Moreover, African American men experience an earlier age of onset of PrCA and are more likely to present with advanced disease. Although the U.S. Preventive Services Task Force (USPSTF) previously recommended against PrCa screening, updated draft guidelines now recommend that patients and clinicians engage in a shared decision- making process to determine on an individualize basis who should utilize PrCa screening. This shared decision-making process poses unique challenges for African American men, given that clinical trials of PrCa screening have lacked racial diversity and thus contribute limited medical evidence, and given structural factors that impede shared healthcare decision making such as greater likelihood of health literacy concerns. Given that Louisiana has the 2nd highest incidence and 7th highest mortality rate of PrCa, and given that African Americans constitute nearly half the population of the Greater New Orleans area, Xavier University of Louisiana is uniquely positioned to address cancer health literacy barriers among African Americans and leverage the application of the USPSTF guidelines. The project will be led by PI Margarita Echeverri, PhD, a behavioral and health disparities researcher at Xavier University of Louisiana, and co-PI Michael Hoerger, PhD, MSCR, a clinical psychologist, methodologist, and psychosocial oncology researcher at Tulane University. They have proven track records of developing health education interventions, including Cancer 101 for African Americans (Cancer101AA) and Values and Options in Cancer Care (VOICE), which will be adapted to focus on PrCa screening decisions in this investigation. We propose three aims to improve PrCa screening decision making for African American men. (1) Adapt the Cancer101AA and VOICE educational interventions for PrCa screening decision making based on input from African American men, patients with prostate cancer, and clinicians. (2) Assess the effectiveness of the adapted interventions relative to a control program for improving decision making (knowledge, confidence, and decision self-efficacy) and secondary clinical outcomes (perceptions of risks and benefits, intentions to screen, decision making processes, and patient- clinician communication) in a randomized clinical trial involving 50 clinicians and 200 African American men in primary care. (3) Evaluate the acceptability and effectiveness of the interventions to inform a broader follow-up investigation. This research will build knowledge that may contribute to the reduction of racial disparities in PrCa, guide the development of a definitive clinical trial that would shift policy and guidelines nationwide, and further develop the capacity for cancer disparities research in Louisiana.
