Decision Aids to Address Prostate Cancer Disparities in Minority Men

描述(由申请人提供)：非裔美国人和一些美国原住民男性在美国经历了更大的前列腺癌负担。手术和放射治疗都是有效的治疗方法，但每种疗法对男性及其伴侣的生活质量都有不同的影响。这些治疗虽然有可能挽救生命，但它们自身也会产生与治疗副作用有关的负担。如果一些男性患有早期、生长缓慢的前列腺癌，他们可能会受益于一种名为“主动监测”的监测方法。做出正确的治疗选择取决于为男性提供所有适当的选择，并确保他们与专业提供者进行高质量的对话。尤其是少数族裔男性并不总是 他们为自己做出正确选择所需的证据，医生和医疗保健系统可能并不总是关注对他们来说重要的东西。被称为“决策辅助”的工具可以提高知识，并可能减轻与前列腺癌治疗相关的少数民族男性的负担。这些工具让男性了解他们的疾病严重程度、治疗方案以及每个治疗方案对生活质量的影响。它们可以在与专家进行临床讨论时提供，也可以在拜访专家之前提供。然而，在前列腺癌的专业实践中，辅助决策并不是常规的美元。我们开发了一种基于平板电脑的工具，前列腺癌选择，帮助男性根据他们的疾病风险、预期寿命以及当前的性功能和尿路功能来定制他们的选择。可以在临床对话中使用。另一个了解你的选择的工具是一个网站，里面有全面的教育材料，设计用于在拜访专家之前使用。我们想研究两种决策辅助工具--一种是在专科医生会诊时提供的，另一种是在看专家之前提供的，以及这两种辅助决策工具的组合--看看我们是否能将患者置于可能的最佳位置，以做出适合他们的治疗选择。我们认为，这些工具将减少患者知识方面的已知差距，并可能改善前列腺癌诊断一年后男性症状的负担。我们提出了一个实验，通过分配32个专业实践来获得不同类型的决策辅助或常规护理，从而提供两种类型的决策辅助。为了测试这项实验，我们将招募310名男性(120名白人，120名非裔美国人，70名美国印第安人/阿拉斯加原住民)。从这项实验中，我们将看到与通常的护理相比，这两种辅助决策工具中的哪一种或两者的组合最能提高男性的知识水平。我们将能够确定这些影响对不同种族背景和教育水平的男性是相同的还是不同的。通过测试这些工具，我们将确定它们是否可以减少少数民族男性在患者知识和生活质量方面的已知差距。

DESCRIPTION (provided by applicant): African American and some Native American men experience a greater burden of prostate cancer in the United States. Surgery and radiation therapy are effective treatments, but each has different quality of life implications for men and their partners. These treatments, although potentially life-saving impose their own burden related to treatment side effects. Some men may benefit from a monitoring approach called "active surveillance" if they have early, slow-growing prostate cancer. Making the right treatment choice depends of men being given all appropriate options and making sure they have a high quality conversation with their specialty provider. Minority men in particular are not always given the evidence they need to make the right choice for them, and doctors and healthcare systems may not always pay attention to what is important to them. Tools called "decision aids" can improve knowledge and may reduce the burden associated with prostate cancer treatment in minority men. These tools inform men about their disease severity, treatment options, and the quality of life implications of each treatment option. They can be delivered in clinical discussion with specialists or prior to a visit with a specialist. However, decision aids are not routinely usd in specialty practice for prostate cancer. A tablet-based tool we have developed, Prostate Choice, helps men tailor their choice based on their disease risk, life expectancy, and current sexual and urinary function. It can be used in the clinical conversation. Another tool, Knowing Your Options, is a website with comprehensive educational materials that is designed for use prior to visits with specialists. We want to study two kinds of decision aids - ones delivered in te visit with a specialist and one delivered before seeing a specialist as well as the combination of the two decision aids-to see if we can put patients in the best position possible to make the treatment choice that is right for them. We think these tools will reduce known disparities in patient knowledge and may improve the burden of men's symptoms a year after prostate cancer diagnosis. We propose an experiment that delivers the two types of decision aids compared to usual care by assigning 32 specialty practices to get different types of decision aids or usual care. To test the experiment we will enroll 310 men (120 white, 120 African American, 70 American Indian/Alaska Native). From this experiment we will see whether one or the other of the two proposed decision aids or the combination of the two improves men's knowledge most compared to usual care. We will be able to determine whether those effects are the same or different for men from different racial backgrounds and education levels. By testing these tools we will determine whether they can reduce known disparities in patient knowledge and quality of life in minority men.