Prostate Cancer Screening: Fostering Informed Decisions

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DESCRIPTION (provided by applicant): In 2002 it is expected that prostate cancer (PCa) will be diagnosed in 189,000 men and will be responsible for 30,200 deaths in the U.S. In spite of the significant disease burden presented by PCa, the utility of screening asymptomatic men remains controversial, as it has not yet been demonstrated by a randomized trial that early diagnosis and treatment of PCa reduces disease-related mortality. The primary goal of the proposed study is neither to encourage nor discourage PCa screening, but to evaluate a method of patient education that is designed to provide detailed screening and treatment-related information and to clarify patient preferences and values, ultimately assisting men in making an informed screening decision. The target population for this educational intervention will be men who have registered to undergo PCa screening within a free, mass screening program. Although at first this may appear to be an atypical group to target for an educational intervention, we present information suggesting that this population represents a large and uniformed group for whom effective and inexpensive methods of education are of critical importance. Participants are men who register for the annual PCa mass screening programs held at Georgetown University and at Howard University. During the 2004 and 2005 screening programs, we will accrue a total of 770 men (385 African American men, 385 Caucasian men). Men will call to register for screening at least 3-6 weeks prior to screening, and we will then call men to describe the project further and to enroll those who wish to participate. Following enrollment and the baseline interview, participants will be randomly assigned to one of four groups: 1) Information plus Decision Aid received one week prior to the scheduled screening date (IDA-home); 2) Information plus Decision Aid received on the day of screening (IDA-clinic); 3) Usual Care information received one week prior to the scheduled screening date (UC-home); or 4) Usual Care information received on the day of the screening (UC-clinic). Follow-up assessments will be conducted post-screening, post-screening results, and one-year post-intervention, to measure knowledge, decisional conflict, decisional satisfaction, and the actual screening decision. We will utilize a 2 (IDA/UC) X 2 (Home (Clinic) repeated measures analysis of covariance and multiple regression to assess for group differences on these outcomes. If found to be effective, the long-term goal of this research program is to disseminate this informational decision aid to mass screening programs throughout the United States.