Fostering informed-decision making about prostate cancer screening, diagnosis and treatment among clinicians and African American men

研究项目3：促进临床医生和非洲裔美国男性对前列腺癌的知情决策 项目总结/摘要 尽管美国多年来积极的前列腺癌（PrCa）筛查实践和死亡率下降， 非裔美国人的PrCa发病率和死亡率仍然最高。此外，非裔美国人 男性出现PrCA的年龄较早，更有可能出现晚期疾病。 尽管美国预防服务工作组（USPSTF）先前建议反对PrCa 筛查，更新的指南草案现在建议患者和临床医生共同做出决定- 制定程序，以确定在个性化的基础上谁应该使用PrCa筛查。此共享 决策过程对非洲裔美国人构成了独特的挑战，因为PrCa的临床试验 筛查缺乏种族多样性，因此提供的医学证据有限， 这阻碍了共同的医疗保健决策，例如更大的健康素养问题的可能性。给定 路易斯安那州的PrCa发病率第二高，死亡率第七高， 美国人占大新奥尔良地区人口的近一半，泽维尔大学 路易斯安那州在解决非裔美国人的癌症健康知识障碍方面具有独特的地位， 利用USPSTF指南的应用。该项目将由PI Margarita Echeverri博士领导， 路易斯安那州泽维尔大学的行为和健康差异研究员，和共同PI迈克尔Hoerger， 博士，MSCR，临床心理学家，方法学家，杜兰大学的心理社会肿瘤学研究员 大学他们已经证明了发展健康教育干预措施的记录，包括癌症101 非裔美国人（Cancer 101 AA）和癌症护理的价值观和选择（VOICE），这将是适应 在这次调查中关注PrCa筛查决定我们提出了三个目标，以改善PrCa筛查 非裔美国人的决策。(1)调整Cancer 101 AA和VOICE教育干预措施 对于PrCa筛查决策，基于非洲裔美国男性，前列腺癌患者， 和临床医生。(2)评估调整后的干预措施相对于控制计划的有效性， 改善决策（知识，信心和决策自我效能）和二级临床 结果（风险和获益的感知、筛查意图、决策过程和患者- 临床医生沟通），在一项随机临床试验中，涉及50名临床医生和200名非洲裔美国男性， 初级保健. (3)评价干预措施的可接受性和有效性，以便为更广泛的后续行动提供信息 调查这项研究将建立知识，可能有助于减少种族差异， PrCa，指导确定性临床试验的开发，该试验将在全国范围内改变政策和指导方针，并且 进一步发展路易斯安那州癌症差异研究的能力。

Research Project 3: Fostering informed decision-making on prostate cancer among Clinicians and African American men Project Summary/Abstract Despite years of aggressive prostate cancer (PrCa) screening practices and declines in mortality in the U.S., African American men still have the highest PrCa incidence and mortality rates. Moreover, African American men experience an earlier age of onset of PrCA and are more likely to present with advanced disease. Although the U.S. Preventive Services Task Force (USPSTF) previously recommended against PrCa screening, updated draft guidelines now recommend that patients and clinicians engage in a shared decision- making process to determine on an individualize basis who should utilize PrCa screening. This shared decision-making process poses unique challenges for African American men, given that clinical trials of PrCa screening have lacked racial diversity and thus contribute limited medical evidence, and given structural factors that impede shared healthcare decision making such as greater likelihood of health literacy concerns. Given that Louisiana has the 2nd highest incidence and 7th highest mortality rate of PrCa, and given that African Americans constitute nearly half the population of the Greater New Orleans area, Xavier University of Louisiana is uniquely positioned to address cancer health literacy barriers among African Americans and leverage the application of the USPSTF guidelines. The project will be led by PI Margarita Echeverri, PhD, a behavioral and health disparities researcher at Xavier University of Louisiana, and co-PI Michael Hoerger, PhD, MSCR, a clinical psychologist, methodologist, and psychosocial oncology researcher at Tulane University. They have proven track records of developing health education interventions, including Cancer 101 for African Americans (Cancer101AA) and Values and Options in Cancer Care (VOICE), which will be adapted to focus on PrCa screening decisions in this investigation. We propose three aims to improve PrCa screening decision making for African American men. (1) Adapt the Cancer101AA and VOICE educational interventions for PrCa screening decision making based on input from African American men, patients with prostate cancer, and clinicians. (2) Assess the effectiveness of the adapted interventions relative to a control program for improving decision making (knowledge, confidence, and decision self-efficacy) and secondary clinical outcomes (perceptions of risks and benefits, intentions to screen, decision making processes, and patient- clinician communication) in a randomized clinical trial involving 50 clinicians and 200 African American men in primary care. (3) Evaluate the acceptability and effectiveness of the interventions to inform a broader follow-up investigation. This research will build knowledge that may contribute to the reduction of racial disparities in PrCa, guide the development of a definitive clinical trial that would shift policy and guidelines nationwide, and further develop the capacity for cancer disparities research in Louisiana.