Prostate-cancer (CaP) screening decision aid for black men designed to enhance shared decision-making

Abstract

6059 Background: The high CaP incidence and mortality of black men combined with their relatively low rate of CaP screening and their elevated risk of presenting with advanced disease has led to their being identified as a high-priority group for screening. The benefit of screening, however, is uncertain. Most guidelines recommend that men make an individualized screening decision in consultation with their doctor. Motivating and preparing men to actively participate in this difficult decision remains a challenge. This is particularly relevant regarding black Americans given their historical alienation from the health care system. Methods: A CaP screening decision aid designed to promote shared decision-making was tested in 5 small group sessions of black men at community sites in Boston. The decision aid was preceded by a brief didactic presentation on CaP screening. The decision aid included a graphical depiction of all potential major outcomes that may follow a decision for or against screening. Vignettes about the decision-making and outcomes of hypothetical men with different life circumstances and priorities were presented to enhance values clarification by the participants. Endpoints measured before and after the intervention included self efficacy (SE)[Decision Self Efficacy Scale], decisional conflict (DC) [Decisional Conflict Scale], desire for autonomy (DFA) [Control Preferences Scale], and prostate cancer knowledge (PCK) [Prostate Cancer Knowledge and Prostate Cancer Screening Knowledge scales]. Pre- and post-intervention scores were compared using a Wilcoxon Matched-Pairs Signed Rank test. Results: 64 men were accrued over 4 months during 2005. Significant changes were seen in all measures. Average scores improved 16% on SE (p<.001) and 17% on DC (p<.004). DFA increased, with the proportion of men wanting to play a dominant role in health care decisions rising from 62% to 81% (p<.001). PCK more than doubled on both scales (p<.001). Focus groups held after the intervention reinforced these findings. Conclusions: Men were better informed, felt better prepared to actively participate in CaP screening decisions, and wanted to play a stronger role in decisions about their health care following exposure to our decision aid. No significant financial relationships to disclose.