These data demonstrate that men in the general public, aged 40 to 70 years without a personal history of prostate cancer, consider prostate cancer genetic testing related to four value-based factor domains, similar to past literature findings on genetic testing for hereditary cancer risk. The motivation factor, which measures values of influence by others, is the strongest decision factor in guiding their opting for the test. More than 80% of men interviewed would consider getting tested if the test was available now. Their stated intention, as measured by the four intent items, is highly correlated with how strongly they feel they are motivated toward the test and inversely related to family influences. Men with strong motivation to get tested also have significantly lower concerns about psychological distress and higher levels of positive expectations. The recommendations of physicians and geneticists are important to men's expressed motivation, although the professionals did not appear to be more influential than their kin.
A respondent is more likely to want the test if he believes that the test may be informative of family risk and may lead to early identification and prevention of cancer (as part of the Positive Expectations domain). The influences of kin, along with beliefs in family risk, highlight the importance of reviewing family-related risk information as part of genetic consultation and informed consent. Men undergoing informed consent for hereditary prostate cancer risk in the future not only should be provided information on what genetic testing can and cannot do for them, but also what the test results could mean for others surrounding them (as evidenced by the influences of family, etc.).
Prior hereditary breast cancer (BRCA) and colorectal cancer (CRC) literature has noted anecdotally that perception of benefit to one's family influences genetic test uptake. Eliciting patient perceptions of concerns regarding their family may be beneficial to consider in oncology genetic testing generally. Similar to this literature, intention was found to be influenced by the respondent's concerns about test validity, test accuracy, and by the availability of interventions that may lead to favorable outcomes. Not surprisingly, men who were concerned about potential psychological distress were less likely to want the test. One unanswered question is how men's anticipatory distress and expected adverse consequences may affect how family risk information is interpreted and discussed. Few men in our study anticipated high levels of distress. Although literature data clearly show elevated distress among patients and their family members [21
]. More research is needed to better establish the family-risk construct and how it may be influenced by other beliefs and values.
The present study has limitations. Given the exploratory nature of factor analysis, these data are aimed at identifying coherent subsets of variables for data reduction, not at identifying specific attitude statements that discriminate skeptics from supporters. Nevertheless, the reduced set of 34 items is the most important among the administered 57 items, and comprises a coherent and reliable assessment tool of eliciting values and intention toward testing. This item set can thereby serve as a foundation for a confirmatory health beliefs model, using Structural Equation Modeling techniques to better elucidate the interactions of these value-based domains [22
]. Also, we noted that this population had somewhat higher income and education levels than the overall Philadelphia Consolidated Metropolitan Statistical Area (CMSA). 51% of men had over $75,000 income, compared with the 32% in the Philadelphia CMSA 2000 census year dataset, and 41% had completed a Bachelor's degree or higher, compared with 28% in the CMSA. These differences may be due to affluent subjects living in suburban counties in the metropolitan Philadelphia area, who then self-select to be seen by physicians in the University of Pennsylvania system. As noted above, our prior work demonstrated no demographic differences except education (with more education correlating with diminished intention). Thus, we do not foresee an adverse impact of these discrepancies on the overall outcomes of our analysis [20
Future directions of this research may include exploring the relationship between stated intent in prostate cancer genetic screening and actual testing behavior when testing is available. Studies have shown that expressed intention does not necessarily translate to actual behavior in taking genetic tests for breast and colorectal cancers [10
]. The same discrepancy between attitude and behavior may exist when a test for prostate cancer is available for the general public. Our data suggest that potential psychological distress, worries about test validity, insurance, confidentiality, and the uncertainties in subsequent intervention decisions may need to be balanced with family considerations when testing becomes available [30