Prostate cancer health literacy in rural versus urban African-American men.

描述（由申请人提供）：前列腺癌是美国男性中最常诊断的非皮肤癌，也是癌症死亡的第二大原因。据估计，2008年将有186，320名男性被诊断患有前列腺癌，28，660名男性将死于前列腺癌。前列腺癌不成比例地影响非洲裔美国男性，他们的发病率是白色男性的1.7倍，死亡率是2.4倍。因此，前列腺癌是健康差距的一个重要来源。我们将使用来自共同决策领域的渥太华决策支持框架（ODSF），从两个诊所照顾大量服务不足的人群中检查非裔美国男性的前列腺癌健康素养。价值澄清和风险沟通是前列腺癌筛查决策过程的核心，因为筛查尚未显示出降低癌症死亡率，但治疗的副作用是普遍和长期的。对于医生和患者来说，能够准确地讨论通常由治疗引起的阳痿，失禁和肠道症状至关重要，因此患者可以决定是否接受前列腺癌筛查。在初步研究中，我们回顾了患者教育材料，以确定前列腺癌健康素养的六个特定领域。这些领域包括患者学习新信息所需的技能和患者在基线时假定拥有的知识。在两个低收入诊所对非裔美国人进行的初步结构化访谈中，我们发现许多患者没有消费者被认为拥有的健康素养技能或知识。因此，我们假设患者不太可能从疾病控制中心（CDC）和国家癌症研究所（NCI）提供的标准材料中了解足够的前列腺癌信息，以参与大多数卫生机构目前推荐的共同决策。我们与NCI的癌症信息服务中心、霍华德大学和西弗吉尼亚州农村的拖船河健康协会建立了合作，以探讨这一假设。使用结构化访谈，我们将描述疾病预防控制中心和国家癌症研究所前列腺癌决策指南的理解，重点是数字和图形风险沟通的男性与穷人的阅读技能。我们将把我们的研究与该领域的其他工作联系起来，使用最近开发的计算能力量表，将数学技能和阅读技能与患者如何理解筛查决定的不确定性联系起来。我们将使用定性的方法和概念隐喻，探索如何改善沟通和共同决策的非裔美国男子识字能力低。研究结果将用于修订前列腺癌教育材料，使识字能力低的男性更容易获得。公共卫生相关性：前列腺癌死亡率是非洲裔美国男性健康差异的重要来源。在初步研究中，我们已经确定了从两个农村，低收入诊所招募的非裔美国男性前列腺癌健康素养的障碍。我们将使用定性方法来确定克服这些障碍的技术，并比较农村和城市非洲裔美国人之间的任何差异。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.