Fostering shared decision-making about prostate cancer screening among African American men patients and their primary care providers: a randomized behavioral clinical trial

Abstract

Background Prostate cancer is the third most prevalent cancer in the American population. Furthermore, the prognosis is worse in African American as there is increased morbidity and mortality associated with it. Purpose The purpose of this study is to evaluate the effectiveness of a new online method to educate the patient population regarding prostate cancer risk, diagnosis, treatments, and their decisions about whether to be screened for the early detection of prostate cancer. Methods Two hundred Black male patients are recruited from different clinical sites and randomized to either the control arm (usual care) or the intervention arm (educational program). We will compare the effectiveness of the intervention to see if patients are discussing the need of getting a prostate-specific antigen (PSA) test, and the possible benefits and harms that may result of having or not having the test, with their primary care providers. Discussion Shared decision-making (SDM) is the current standard in most cancer-screening guidelines and also a standard of person-centered care. However, there is a lack of evidence-based approaches to improve decision quality in clinical settings and an increased ambiguity of applying SDM for PSA-based screening among Black men in primary care. Our proposal to evaluate a decisional-aid intervention and measure the actual application of SDM during clinical encounters has a high potential to advance the translation path of implementing shared decision-making in clinical settings and provide evidence of the applicability of the guideline in general. Innovation and overall impact Given the 2018 USPSTF updated guidelines recommending shared decision-making about PSA-based screening, the increased risk of prostate cancer mortality in Black men, the challenges of evidence-based decision-making due to the underrepresentation of Blacks in major randomized clinical trials, and implicit racial bias among primary care providers, the time is ripe for interventions to improve shared decision-making about prostate cancer screening in Black men. In this study, we address communication and knowledge gaps between Black men and their primary care providers. The intervention, if proven effective, can be readily scaled across primary care practices across the U.S. and may be adapted to other types of cancer where guidelines have included shared decision-making as well. Early detection of prostate cancer may decrease mortality and morbidity in the long term.

Disparities in Diagnosis, Treatment Access, and Time to Treatment Among Hispanic Men With Metastatic Prostate Cancer

“…Carlson et al demonstrated that education at the time of prostate cancer screening in the setting of outreach events increases patient knowledge and additional randomized trials are underway. [42][43][44] Targeted community outreach programs such as barbershop engagement programs are feasible among Black patients 45 ; similar creative interventions informed by cultural humility should be explored in other minority groups including Hispanic men. In the more advanced disease states, interventional studies are sorely needed.…”

Editorial Comment

“…A currently accruing trial of Black men undergoing PSA screening employs an online decision aid and evaluates outcomes including patient engagement scores, prostate cancer knowledge, and decisional confidence, self-efficacy, and satisfaction. 3 These studies offer tools to augment men’s understanding of their prostate health, and may mitigate the time pressures of a busy clinical practice while achieving health equity. Further, decision aids should be culturally tailored to minority men, especially those who are non-English speaking.…”