Promoting informed prostate cancer screening decision-making for African American men in a community-based setting.

PURPOSE: Current screening guidelines for prostate cancer (PCa) encourage men to make individual screening decisions after consulting with their primary care provider to weigh the risks and benefits of undergoing prostate specific antigen (PSA) testing, but many men at high risk of PCa diagnosis (notably African American men) are more likely to be uninsured and lack a primary care provider. An academic-community partnership redesigned its community-based screening program to ensure access to services for African American men, incorporating a session with a trained clinical educator in community settings, designed to increase knowledge and promote informed decision-making regarding PSA testing. This study evaluated effects of the intervention on decision-making outcomes. METHODS: To evaluate program efficacy, 88 men completed pre- and post-test surveys assessing outcomes of interest. RESULTS: Participants' knowledge, beliefs, attitudes, anxiety levels, and self-efficacy all improved from pre- to post-test at a statistically significant level. Most notably participants' awareness that PCa is often not life-threatening, and watchful waiting is a reasonable treatment option increased after the encounter. More than half of the study sample felt they had received enough knowledge to make an informed decision about whether the PSA test was right for them. CONCLUSION: Our findings show the program had positive effects on men's ability to make informed decisions about PCa screening and demonstrate that educational outreach programs with an emphasis on informed decision-making can effectively balance screening guidelines with the needs of underserved populations in community settings to improve outcomes.

Prostate cancer survivors as community health educators: implications for informed decision making and cancer communication.

Recent evidence questioning the effectiveness of prostate-specific antigen testing leave community-based prostate cancer (CaP) outreach programs with a dilemma between promoting screening and highlighting screening risks. CaP survivors are uniquely positioned to address this problem by drawing upon real-life experiences to share nuanced information and perspectives. While CaP survivors have historically been incorporated into outreach programs, little is known about their impact on psychosocial outcomes and their effectiveness compared to professional health educators. This study addressed these gaps through a quasi-experimental design where African American men attended a CaP screening session conducted by a health educator (HE) or survivor educator (SV). The presentation included prostate cancer statistics, CaP information, and descriptions of CaP screening tests. SV were encouraged to bolster their presentations with personal stories whereas HE maintained fidelity to the curriculum content. All participants completed pre- and post-test questionnaires. Our sample comprised a total of 63 participants (HE group = 32; SV group = 31) with an age range of 40-70 years. Decision self-efficacy increased significantly in the SV group (p = 0.01) whereas perceived screening risks reduced significantly in the HE group (p < 0.001). No significant changes were found in knowledge, subjective norms, outcome expectancies, and screening benefits. Survivor educators were found to have significantly greater appeal (p = 0.03), identification with audience (p = 0.01), and liking (p = 0.03). Training CaP survivors as health educators might be a viable strategy for community-based cancer communication efforts confronted by the CaP screening controversy. We discuss conceptual and programmatic implications of our findings and present directions for future research.

Addressing the challenge of informed decision making in prostate cancer community outreach to African American men.

African American men are disproportionately affected by prostate cancer. This project adopted a community-based participatory approach to design and pilot test an educational outreach strategy that promotes informed decision making about screening among African American men in community settings in St. Louis, Missouri. Interviews with local subject matter experts informed the design of the strategy. The revised curriculum was pilot tested in 2009 with 63 men who completed pre- and posttest surveys that measured knowledge, norms, beliefs, decision self-efficacy, and screening intention. The intervention resulted in statistically significant improvement in prostate cancer knowledge, decreased perceived risks and barriers, and increased screening decision self-efficacy. The educational outreach strategy offered in community settings was effective in improving knowledge, beliefs, and decision self-efficacy related to prostate cancer screening. This project sought to devise a screening outreach strategy that struck a balance between the imperatives of informed decision-making goals and the pragmatics of community settings. The findings suggest the need for further research to assess the effectiveness of community-based outreach efforts in enhancing engagement of men in decision making related to screening, diagnostics, and treatment.