Screening for prostate cancer is controversial. The American Urological Association and the American Cancer Society recommend that screening should be offered to men annually beginning at age 50 or at an earlier age (e.g., 45 years) for men in high-risk groups, such as African Americans - based on their two to three times increased prostate cancer mortality. However, decision analytic models have demonstrated that the net benefit of prostate cancer screening depends on how men value the common side effects of treatment (impotence, incontinence, and bowel symptoms) as measured using utility assessment. Despite the critical importance of utilities to the screening decision, few data exist regarding preferences for the side effects of treatment. The candidate will focus her research on adapting the methods of health status assessment and utility measurement for use in a research population that emphasizes rural African American men to explore the policy implications of race- and age-specific prostate cancer screening guidelines.
Specific aims of this proposal are: 1) to adapt and pilot a health status instrument, utility assessment interview and an interview of ethnic and cultural beliefs regarding prostate cancer for use in a rural African American population 2) to assess utilities and relevant covariates (including sociodemographics, cultural beliefs, and baseline prostate-specific health) in a cohort of 450 men from the general public (225 largely rural African-American men, 225 non-African American men) and 125 physicians using these instruments 3) to analyze the data to investigate potential differences in utilities by group (e.g., African American versus non-African American, younger versus older men, physicians versus men in the general public) controlling for these covariates in a multivariable model. The proposed investigation will contribute new information regarding patient preferences directly applicable to health policy, quality-of-life, and cost-effectiveness analyses. Results will be incorporated into decision support tools to assist men faced with the decision whether to be screened for prostate cancer. The proposal will provide the candidate with critical new skills in cancer prevention, medical anthropology, instrument development, multivariable statistical modeling, and ethnic minority psychology. This research will be performed at the University of Virginia Departments of Anthropology, Health Evaluation Sciences, and Medicine; Washington University and Massachusetts General Hospital. These collaborations will foster the candidate's career in Outcomes Research and ensure the project's success.
| Kilbridge, Kerry L; Fraser, Gertrude; Krahn, Murray et al. (2009) Lack of comprehension of common prostate cancer terms in an underserved population. J Clin Oncol 27:2015-21 |
| Jones, Randy A; Taylor, Ann Gill; Bourguignon, Cheryl et al. (2008) Family interactions among African American prostate cancer survivors. Fam Community Health 31:213-20 |
