Prostate cancer is the most common cancer and second leading cause of cancer death among all men in the United States.1
However, substantial racial/ethnic disparities exist, with incidence rates for prostate cancer that are 60% higher for African-American (AA) men than for White men and mortality rates that are 2.4 times more likely among AA men than White men.1
Methods for primary prevention of prostate cancer are not well established. Therefore, cancer prevention and control efforts have primarily focused on early detection of the disease. While screening methods (prostate-specific antigen test (PSA) and the digital rectal exam (DRE)) are widely available, there is currently insufficient evidence to warrant population-based screening for prostate cancer among average-risk men.2
While there are no race-specific recommendations for prostate cancer screening, some organizations, including the American Cancer Society and NCI, suggest that higher-risk populations, such as men of African descent and those with a family history of the disease, be counseled about prostate cancer screening beginning at 40 or 45 years of age.1, 3
In light of existing disparities in prostate cancer incidence and mortality, AA men are a priority audience for interventions. There have been a number of trials specifically focused on decision-aids for prostate cancer screening, most of which have used videotaped presentation or print material modalities.4-8
While most of these studies report significant short-term improvements in knowledge, 4-6, 9, 10
relatively few trials have evaluated the impact of interventions on other theoretically-informed outcomes relevant to informed decision-making (IDM), including decision self-efficacy10
and decisional conflict.6, 10
Furthermore, few of these studies have included significant numbers of African-American men.11
Additional studies are needed to understand how to counsel high risk men, such as AAs, to make informed decisions about prostate cancer screening.
Prior studies have shown that faith-based settings are a feasible and acceptable venue in which to provide health information to AA audiences.12
Churches play a prominent role in many AA communities and represent a trusted, credible institution that addresses both spiritual and physical health.12
Faith-based organizations represent a promising community setting in which to implement IDM interventions targeting AA men.12-14
Efforts to promote prostate cancer screening IDM can build upon the existing programs in many AA churches who are already providing health outreach to their congregations.12
The paucity of research in this area highlights the need for additional information about decision-making processes among AA men, so as to improve the delivery of cancer screening interventions among this priority audience.
We present the feasibility of designing and implementing a prostate cancer screening IDM intervention in a faith-based setting, and assess initial changes in knowledge, self-efficacy and decisional conflict. The intervention was conducted in churches by an experienced, AA male health educator in a small group setting. Consistent with the definition of ‘informed decision-making’ described in the US Preventive Services Task Force,15
the objectives of the intervention were to: (1) increase knowledge about the benefits, risks and limitations of prostate cancer screening; and (2) promote confidence in men’s ability to participate in the decision making process at a level that is personally desired (decision self-efficacy). Additionally, we assessed whether the intervention induced uncertainty (decisional conflict) about prostate cancer screening, and the extent to which men’s desire for control in decision-making (control preferences) was affected by the intervention.