Randomized trial of community health worker-led decision coaching to promote shared decision making for prostate cancer screening among Black male patients and their providers

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Prostate cancer is the most common non-cutaneous malignancy among men in the United States and affects Black men disproportionately. Experts agree prostate-specific antigen (PSA)–based prostate cancer screening is a preference-sensitive decision and recommend Shared Decision Making (SDM). The US Preventative Services Task Force (USPSTF) recently proposed a revision of their Prostate Cancer Screening Statement, now encouraging that screening decisions happen within a SDM framework based on professional judgment and patient preference. USPSTF has also recognized SDM is underutilized in practice, especially among Black men, and has emphasized the need for research to understand how best to implement and adapt SDM programs within diverse populations. We seek to optimize, evaluate and disseminate a program to help Black men understand their increased risk of prostate cancer and receive guidance sensitive to their values and preferences when deciding about PSA screening. Our group demonstrated the utility of employing a community health worker (CHW) to help Black men decide about PSA screening. Several critical knowledge gaps remain in the literature: 1) will CHW Decision Coaching improve decisions among Black men considering PSA screening? 2) will CHW Decision Coaching improve providers’ experience with PSA counseling? 3) how much will a CHW Decision Coach intervention cost? We propose a CHW-led Decision Coaching program to facilitate SDM for prostate cancer screening among Black men from a primary care Federally Qualified Health Center (FQHC). Patients will be randomized either to 1) receiving a decision aid along with CHW-led Decision Coaching on PSA screening or 2) receiving a decision aid along with CHW-led interaction on an unrelated healthcare topic. Among patients we will assess decision quality and use of PSA screening. Among providers we will assess perceptions of the acceptability and feasibility of the intervention. We will explore communication in both groups. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured in-depth interviews and thematic analysis of clinical encounters. Through a conceptual model that combines elements of the Preventative Health Care Model (PHM) and Informed Decision Making Model, we hypothesize that the decision coaching intervention will positively impact factors that empower preference clarification, decision context, knowledge, and attitudes that will ultimately result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction. Our results will enhance understanding of the efficacy, cost-effectiveness, and sustainability of CHW intervention in a community clinic setting. Findings will inform the subsequent design of a scalable intervention to promote adoption and integration of SDM across contexts and empower high-risk, vulnerable populations.