Prostate Cancer Detection Decision-Making for Low-Income African American Men

低收入非裔美国男性的前列腺癌检测决策

• 批准号: 8411716
• 负责人: RENA Joy PASICK
• 金额: $ 17.05万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-05 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8411716
• 关键词: Address; Advocacy; African American; Anthropology; Area; Biopsy; Cancer Detection; Caring; Clinic; Commit; Communication; Communication Research; Communities; Comprehensive Cancer Center; Conflict (Psychology); Counseling; Decision Aid; Decision Making; Disease; Early Diagnosis; Early treatment; Education; Effectiveness; Ethnic Origin; Ethnic group; Excess Mortality; Family; Fostering; Goals; Guidelines; Health; Health Communication; Health Fairs; Healthcare; Incidence; Individual; Influentials; Interview; Left; Literature; Low income; Malignant neoplasm of prostate; Measures; Medicine; Methods; Mission; Not Hispanic or Latino; PSA screening; Patients; Patterns of Care; Phase; Physicians; Pilot Projects; Population; Positioning Attribute; Primary Health Care; Process; Prostate; Protocols documentation; Provider; Public Health; Race; Radiation Oncology; Recommendation; Records; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Sampling; San Francisco; Screening for cancer; Social Sciences; Staging; Surveys; Test Result; Testing; Time; Uninsured; Urology; base; cancer health disparity; community based participatory research; disorder risk; experience; health literacy; high risk; literacy; men; mortality; preference; public health relevance; safety net; screening; shared decision making; skills; theories

DESCRIPTION (provided by applicant): Excess mortality due to prostate cancer among African American men is one of the most intractable cancer disparities. In the San Francisco Bay Area, incidence in this group is 40 percent higher and mortality is more than twice that for non-Hispanic White men. Research to increase early detection in this high risk group has stalled due to controversies surrounding the efficacy of the PSA test and even though the equivocal studies that tested the PSA did not include adequate samples of African American men. Resulting national guidelines emphasize shared decision-making (SDM) prior to PSA testing, a process to elucidate a patient's values and preferences and to foster his understanding of the limitations of the test. Because disproportionately more African American men have low literacy skills, it is not clear whether SDM is feasible or commonly practiced in settings where low-income men and/or those of low educational attainment access cancer screening such as health fairs and public health clinics. We propose first to ascertain current and best possible pre-screening SDM communication practices in these settings. Second, because the PSA debate is largely due to over-treatment of low-risk disease and since approximately 95 percent of PSA test results are normal, we will explore the feasibility of shifting the focus of SDM from screenin to pre-biopsy counseling for the 5 percent of men with elevated PSAs. For this community-based participatory and mixed methods study, our specific aims are: 1. To document current practices in shared decision-making for PSA testing where uninsured, low-income and/or low-literacy African American men obtain screening, and to explore the potential for effective SDM communication in these settings. a. conduct in-depth interviews with 20 clinicians, 20 staff, and 20 patients regarding SDM and screening to ascertain key concepts, barriers, and facilitators, and to inform survey questions; b. conduct observations of 200 men at community screenings to document SDM in these settings; c. measure PSA test and SDM practices, preferences and confidence regarding SDM, barriers to SDM, and tailoring by race/ethnicity and health literacy in a survey of 150 providers with practices of at least 10 percent African American patients. 2. To assess the feasibility of pre-biopsy counseling (PBC) for African American men with an elevated PSA by pilot testing a theory-based PBC protocol with 40 men with a recent abnormal test.

描述（由申请人提供）：非裔美国男性中前列腺癌导致的超额死亡率是最棘手的癌症差异之一。在旧金山弗朗西斯科湾区，这一群体的发病率高出40%，死亡率是非西班牙裔白色男性的两倍多。由于围绕PSA测试有效性的争议，增加这一高危人群早期检测的研究已经停滞，尽管测试PSA的模棱两可的研究没有包括足够的非裔美国人样本。由此产生的国家指南强调PSA检测前的共同决策（SDM），这是一个阐明患者价值观和偏好并促进他对检测局限性的理解的过程。由于不成比例的非洲裔美国人的识字能力低，目前还不清楚SDM是否是可行的或普遍实行的设置，低收入的男子和/或那些低教育程度的访问癌症筛查，如健康博览会和公共卫生诊所。我们建议首先确定当前和最好的可能预先筛选SDM通信的做法，在这些设置。第二，因为PSA争论主要是由于低风险疾病的过度治疗，而且大约95%的PSA检测结果是正常的，我们将探讨将SDM的重点从筛查转移到PSA升高的5%男性的活检前咨询的可行性。对于这个以社区为基础的参与式和混合方法的研究，我们的具体目标是：1。记录目前的做法，在共同决策PSA测试，其中无保险，低收入和/或低识字的非洲裔美国人男子获得筛选，并探讨在这些设置有效的SDM通信的潜力。 a.对20名临床医生、20名工作人员和20名患者进行关于SDM和筛查的深入访谈，以确定关键概念、障碍和促进因素，并告知调查问题; B.在社区筛查中对200名男性进行观察，以记录这些环境中的SDM; c.测量PSA测试和SDM实践，关于SDM的偏好和信心，SDM的障碍，以及在对150名提供者的调查中根据种族/民族和健康素养进行定制，其中至少有10%的非裔美国人患者。2.评估活检前咨询（PBC）的可行性与PSA升高的非洲裔美国男性通过试点测试一个基于理论的PBC协议与40名男性最近异常的测试。