Cancer Control Research5R03CA138136-02
Ukoli, Flora Aroma
PROSTATE CANCER EDUCATION AND SCREENING PILOT PROGRAM FOR AFRICAN-AMERICANS
DESCRIPTION (provided by applicant): Prostate cancer (PCa) mortality rates are higher among African-American than Caucasian- American men, yet they tend not to participate in early detection programs. This trend may be due partly to barriers of accessibility, acceptability, and availability. Other sited barriers are mistrust of the health system, poor relations with providers, perceived threat to male sexuality, poor knowledge and underrated value of screening. Screening for PCa is particularly problematic because of controversy about its benefits, and concerns about treatment related quality of life issues, emphasizing the need for informed decision making. This education intervention will target low-income African-American men, 47 years and older, who did not have a PSA or DRE in the past two years. Primary study outcomes include PCa knowledge, decisional conflict regarding screening, and PCa screening rates. Qualitative analysis will be used to determine screening barrier themes that will be addressed by a culturally appropriate education intervention. Specific Aims: 1). Convene five distinct 12-person focus groups to identify perceived barriers to PCa screening; 2). Convene a 15-person Community Advisory Board (CAB) to assist in the development of an intervention for improving PCa knowledge; 3). Enroll 496 African-American men from the Memphis Health Center (MHC) and the community, and randomize them to 'intervention' and 'usual-care' study arms over a period of 10 months; 4). Evaluate the impact of the intervention on improving PCa knowledge, recognizing decisional conflict regarding PCa screening, and increasing PCa screening rates. Study hypothesis are as follows: a). Knowledge and positive attitude to PCa screening will improve by at least 30% in the entire study group, and by at least 80% in the 'intervention' arm. b). PCa screening rate will increase to at least 50.0% in the 'intervention' arm. c). Overall PCa screening rate at the MHC will increase from 15.0 % to exceed the county rate of 25.0%. d). The rates for subsequent annual PCa screening, screening result resolution, prostate biopsy follow-up, and uptake of definitive treatment will be at least 50.0% higher among men in the 'intervention' arm. Study Design & Methods: This 2-year education intervention will be implemented at the MHC for men who already attend the health center (284) and those who do not (284), stratified by age <65 and e65 years. The study coordinator will implement the assigned intervention after randomization by a non-project staff. PCa screening rates will be compared across study arms for the two age groups, and recruitment sites by chi- square test and with the rate for the MHC. Aggregate PCa knowledge and decisional conflict scores will be generated from survey responses, and compared across baseline, 1-week, and 3-month time points for both study arms using ANOVA. With adequate sample size logistic regressions will be used to determine the demographic and other variables that significantly predict PCa screening behavior across study arms. PUBLIC HEALTH RELEVANCE: "Prostate Cancer Education and Screening Pilot Program for African Americans" African-American men bear an unequal burden for prostate cancer (PCa) compared to other ethnic and racial groups. This project hopes to reduce this burden by improving PCa knowledge and encouraging informed screening decisions among low-income African American men.