1
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Garraway IP, Carlsson SV, Nyame YA, Vassy JL, Chilov M, Fleming M, Frencher SK, George DJ, Kibel AS, King SA, Kittles R, Mahal BA, Pettaway CA, Rebbeck T, Rose B, Vince R, Winn RA, Yamoah K, Oh WK. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM EVIDENCE 2024; 3:EVIDoa2300289. [PMID: 38815168 DOI: 10.1056/evidoa2300289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. METHODS A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. CONCLUSIONS These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
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Affiliation(s)
- Isla P Garraway
- Department of Urology, David Geffen School of Medicine, University of California and Department of Surgical and Perioperative Care, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Sigrid V Carlsson
- Departments of Surgery and Epidemiology and Biostatistics, Urology Service, Memorial Sloan Kettering Cancer Center, New York
- Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, and Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle
- Department of Urology, University of Washington, Seattle
| | - Jason L Vassy
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford and Boston
- Harvard Medical School and Brigham and Women's Hospital, Boston
| | - Marina Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, New York
| | - Mark Fleming
- Virginia Oncology Associates, US Oncology Network, Norfolk, VA
| | - Stanley K Frencher
- Martin Luther King Jr. Community Hospital and University of California, Los Angeles
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Sherita A King
- Section of Urology, Medical College of Georgia at Augusta University and Charlie Norwood Veterans Affairs Medical Center, Augusta, GA
| | - Rick Kittles
- Morehouse School of Medicine, Community Health and Preventive Medicine, Atlanta
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, Miami
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Timothy Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
- Harvard T.H. Chan School of Public Health, Boston
| | - Brent Rose
- Department of Radiation Oncology, University of California, San Diego
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- James A. Haley Veterans' Hospital, Tampa, FL
| | - William K Oh
- Prostate Cancer Foundation, Santa Monica, CA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute at Mount Sinai, New York
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Gökce Mİ, Güven S, Petkova K, Tefik T, İbiş MA, Sönmez G, Gadzhiev N, Kiremit MC, Karagöz MA, Villa L, Sarıca K. Patient compliance for metabolic evaluation and medical treatment (CoMET) in calcium-oxalate stone patients: prospective study by EULIS eCORE study group. World J Urol 2023; 41:3135-3140. [PMID: 37758934 DOI: 10.1007/s00345-023-04610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE In this study, we aimed to identify the compliance rates of calcium-oxalate stone patients for metabolic evaluation, diet and medical treatment and also determine the factors that are associated with poor compliance rates. METHODS This study was conducted by the EULIS eCORE working group prospectively. In the initial visit, demographic and stone-related characteristics were recorded. Patients were suggested metabolic evaluation, dietary advices and medical treatment. Follow-up visit was performed after 3 months and compliance rates were recorded. Logistic regression analysis was performed to determine factors associated with poor compliance to metabolic evaluation, diet and medical treatment. RESULTS Data of 346 patients from nine centers were analyzed. Compliance rates were 71.7%, 65.3%, and 63.7% for metabolic evaluation, diet, and medical treatment, respectively. In multivariate analysis, level of education (p = 0.003), history of emergency department visit (p = 0.04), number of stone surgeries (p = 0.03), patient care in dedicated stone clinic (p = 0.03), and history of shock wave lithotripsy (p = 0.005) were detected as independent predictors of compliance to metabolic analysis. Level of education (p < 0.001) and history of emergency department visit (p = 0.01) were detected as independent predictors of patient compliance to diet. Number of stone episodes (p = 0.03), family history of stones (p = 0.02), and polypharmacy (p < 0.001) were detected as independent predictors of patient compliance to medical treatment. CONCLUSIONS Patient compliance to metabolic evaluation, diet, and medical therapy is important for successful management of urolithiasis. Dietary advices and medications should be personalized by taking in to account the factors associated with poor compliance.
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Affiliation(s)
- Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine, Sancak Mahallesi Turan Güneş Bulvarı, 39/23, Çankaya, 06550, Ankara, Turkey.
| | - Selçuk Güven
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhammed Arif İbiş
- Department of Urology, Ankara University School of Medicine, Sancak Mahallesi Turan Güneş Bulvarı, 39/23, Çankaya, 06550, Ankara, Turkey
| | - Giray Sönmez
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Ali Karagöz
- Department of Urology, Prof. Dr. Cemil Tascıoglu City Hospital Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kemal Sarıca
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
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Herrera DJ, van de Veerdonk W, Berhe NM, Talboom S, van Loo M, Alejos AR, Ferrari A, Van Hal G. Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening. Cancers (Basel) 2023; 15:3867. [PMID: 37568683 PMCID: PMC10417450 DOI: 10.3390/cancers15153867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians' and vulnerable populations' preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients' values. Considering the complexities of patients' and clinicians' preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.
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Affiliation(s)
- Deborah Jael Herrera
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Wessel van de Veerdonk
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Neamin M Berhe
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Société Générale de Surveillance (SGS), 2800 Mechelen, Belgium
| | - Sarah Talboom
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Marlon van Loo
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Andrea Ruiz Alejos
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Allegra Ferrari
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16123 Genoa, Italy
| | - Guido Van Hal
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
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Martinez-Lopez N, Makarov DV, Thomas J, Ciprut S, Hickman T, Cole H, Fenstermaker M, Gold H, Loeb S, Ravenell JE. A Study to Compare a CHW-Led Versus Physician-Led Intervention for Prostate Cancer Screening Decision-Making among Black Men. Ethn Dis 2023; 33:26-32. [PMID: 38846259 PMCID: PMC11152150 DOI: 10.18865/1722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Introduction Prostate cancer is the second leading cause of cancer deaths among men in the United States and harms Black men disproportionately. Most US men are uninformed about many key facts important to make an informed decision about prostate cancer. Most experts agree that it is important for men to learn about these problems as early as possible in their lifetime. Objectives To compare the effect of a community health worker (CHW)-led educational session with a physician-led educational session that counsels Black men about the risks and benefits of prostate-specific antigen (PSA) screening. Methods One hundred eighteen Black men recruited in 8 community-based settings attended a prostate cancer screening education session led by either a CHW or a physician. Participants completed surveys before and after the session to assess knowledge, decisional conflict, and perceptions about the intervention. Both arms used a decision aid that explains the benefits, risks, and controversies of PSA screening and decision coaching. Results There was no significant difference in decisional conflict change by group: 24.31 physician led versus 30.64 CHW led (P=.31). The CHW-led group showed significantly greater improvement on knowledge after intervention, change (SD): 2.6 (2.81) versus 5.1 (3.19), P<.001). However, those in the physician-led group were more likely to agree that the speaker knew a lot about PSA testing (P<.001) and were more likely to trust the speaker (P<.001). Conclusions CHW-led interventions can effectively assist Black men with complex health decision-making in community-based settings. This approach may improve prostate cancer knowledge and equally minimize decisional conflict compared with a physician-led intervention.
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Affiliation(s)
| | - Danil V. Makarov
- Department of Population Health, NYU Langone Health, New York, NY
- Department of Urology, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - Jerry Thomas
- Department of Population Health, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - Shannon Ciprut
- Department of Population Health, NYU Langone Health, New York, NY
- Department of Urology, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - Theodore Hickman
- Department of Population Health, NYU Langone Health, New York, NY
| | - Helen Cole
- Department of Population Health, NYU Langone Health, New York, NY
| | | | - Heather Gold
- Department of Population Health, NYU Langone Health, New York, NY
| | - Stacy Loeb
- Department of Population Health, NYU Langone Health, New York, NY
- Department of Urology, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
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5
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Makarov DV, Feuer Z, Ciprut S, Lopez NM, Fagerlin A, Shedlin M, Gold HT, Li H, Lynch G, Warren R, Ubel P, Ravenell JE. Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers. Trials 2021; 22:128. [PMID: 33568208 PMCID: PMC7876807 DOI: 10.1186/s13063-021-05064-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Black men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality. METHODS We proposed a CHW-led decision-coaching program to facilitate SDM for prostate cancer screening discussions in Black men at a primary care FQHC. This study enrolled Black men who were patients at the participating clinical site and up to 15 providers who cared for them. We estimated to recruit 228 participants, ages 40-69 to be randomized to either (1) a decision aid along with decision coaching on PSA screening from a CHW or (2) receiving a decision aid along with CHW-led interaction on modifying dietary and lifestyle to serve as an attention control. The independent randomization process was implemented within each provider and we controlled for age by dividing patients into two strata: 40-54 years and 55-69 years. This sample size sufficiently powered the detection differences in the primary study outcomes: knowledge, indicative of decision quality, and differences in PSA screening rates. Primary outcome measures for patients will be decision quality and decision regarding whether to undergo PSA screening. Primary outcome measures for providers will be acceptability and feasibility of the intervention. We will examine how decision coaching about prostate cancer screening impact patient-provider communication. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured, in-depth interviews, and thematic analysis of clinical encounters. Through a conceptual model combining elements of the Preventative Health Care Model (PHM) and Informed Decision-Making Model, we hypothesize that the prostate cancer screening decision coaching intervention will result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction with counseling patients about prostate cancer screening. DISCUSSION Decision coaching is an evidence-based approach to improve decision quality in many clinical contexts, but its efficacy is incompletely explored for PSA screening among Black men in primary care. Our proposal to evaluate a CHW-led decision-coaching program for PSA screening has high potential for scalability and public health impact. Our results will determine the efficacy, cost-effectiveness, and sustainability of a CHW intervention in a community clinic setting in order to inform subsequent widespread dissemination, a critical research area highlighted by USPSTF. TRIAL REGISTRATION The trial was registered prospectively with the National Institute of Health registry ( www.clinicaltrials.gov ), registration number NCT03726320 , on October 31, 2018.
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Affiliation(s)
- Danil V Makarov
- VA New York Harbor Healthcare System, 423 E 23rd St, New York, NY, USA.
- Departments of Urology, NYU Langone Health, 227 E 30th St, New York, NY, USA.
- Population Health, NYU Langone Health, 227 E 30th St, New York, NY, USA.
| | - Zachary Feuer
- VA New York Harbor Healthcare System, 423 E 23rd St, New York, NY, USA
- Departments of Urology, NYU Langone Health, 227 E 30th St, New York, NY, USA
| | - Shannon Ciprut
- VA New York Harbor Healthcare System, 423 E 23rd St, New York, NY, USA
- Departments of Urology, NYU Langone Health, 227 E 30th St, New York, NY, USA
- Population Health, NYU Langone Health, 227 E 30th St, New York, NY, USA
| | | | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Heather T Gold
- Population Health, NYU Langone Health, 227 E 30th St, New York, NY, USA
| | - Huilin Li
- Population Health, NYU Langone Health, 227 E 30th St, New York, NY, USA
| | - Gina Lynch
- Sunset Park Health Council, Brooklyn, NY, USA
| | - Rueben Warren
- National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, USA
| | - Peter Ubel
- The Fuqua School of Business, Duke University, Durham, NC, USA
| | - Joseph E Ravenell
- Population Health, NYU Langone Health, 227 E 30th St, New York, NY, USA
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6
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Nguyen DD, Trinh QD, Cole AP, Kilbridge KL, Mahal BA, Hayn M, Hansen M, Han PKJ, Sammon JD. Impact of health literacy on shared decision making for prostate-specific antigen screening in the United States. Cancer 2020; 127:249-256. [PMID: 33165954 DOI: 10.1002/cncr.33239] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Current guidelines endorse shared decision making (SDM) for prostate-specific antigen (PSA) screening. The relationship between a patient's health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening. METHODS Using data from the 2016 Behavioral Risk Factor Surveillance System, the authors examined PSA screening in the 13 states that administered the optional "Health Literacy" module. Men aged ≥50 years were examined. Complex samples multivariable logistic regression models were computed to assess the odds of undergoing PSA screening. The interactions between HL and SDM were also examined. RESULTS A weighted sample of 12.249 million men with a rate of PSA screening of 33.4% were identified. Approximately one-third self-identified as having optimal HL. Rates of PSA screening were found to be highest amongst the highest HL group (42.2%). Being in this group was a significant predictor of undergoing PSA screening (odds ratio, 1.214; 95% confidence interval, 1.051-1.403). There was a significant interaction observed between HL and SDM (P for interaction, <.001) such that higher HL was associated with a lower likelihood of undergoing PSA screening when SDM was present. CONCLUSIONS In the uncertain environment of multiple contradictory screening guidelines, men who reported higher levels of HL were found to have higher levels of screening. The authors demonstrated that increased HL may reduce the screening-promoting effect of SDM. These findings highlight the dynamic interplay between HL and SDM that should inform the creation and promulgation of SDM guidelines, specifically when considering patients with low HL.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P Cole
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kerry L Kilbridge
- Lank Center for Genitourinary Malignancy, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Brandon A Mahal
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matt Hayn
- School of Medicine, Tufts University, Boston, Massachusetts.,Division of Urology, Maine Medical Center, Portland, Maine
| | - Moritz Hansen
- School of Medicine, Tufts University, Boston, Massachusetts.,Division of Urology, Maine Medical Center, Portland, Maine.,Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
| | - Paul K J Han
- School of Medicine, Tufts University, Boston, Massachusetts.,Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
| | - Jesse D Sammon
- School of Medicine, Tufts University, Boston, Massachusetts.,Division of Urology, Maine Medical Center, Portland, Maine.,Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
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7
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Adaptation and Initial Psychometric Evaluation of an Informed Prostate Cancer Screening Decision Self-Efficacy Scale for African-American Men. J Racial Ethn Health Disparities 2020; 7:746-759. [PMID: 31997285 DOI: 10.1007/s40615-020-00702-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men. METHODS Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations. RESULTS Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations. CONCLUSIONS Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.
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8
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Saleh AM, Ebrahim EE, Aldossary EH, Almutairi MAM. The Effect of Prostate Cancer Educational Program on the level of Knowledge and Intention to Screen among Jordanian Men in Amman. Asian Pac J Cancer Prev 2020; 21:211-215. [PMID: 31983186 PMCID: PMC7294022 DOI: 10.31557/apjcp.2020.21.1.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/07/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the effect of prostate cancer educational program on the level of knowledge and intention to screen for prostate cancer among Jordanian men in Amman. METHODS A quasi-experimental, with nonequivalent control group design was used. 154 participants were randomly assigned to the intervention and control groups. Level of Knowledge and intention to screen were measured at baseline and at 1 month after the application of the prostate cancer educational program. Independent sample t-test was used to analyze the data. RESULTS The results showed statistically significant change in the mean knowledge scores (8.7), p < 0.001 and the mean of intention to screen scores (3.71), p < 0.001, after 1 month from the application of the educational program in the experimental group compared to the control group. CONCLUSION Implementing prostate cancer educational programs help enhance knowledge and intention to screen among Jordanian men.
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Affiliation(s)
- Ahmad M Saleh
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Department of Nursing, Alkharj, Riyadh, Saudi Arabia.
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9
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Owens OL, Tavakoli AS, Rose T, Wooten NR. Development and Psychometric Properties of a Prostate Cancer Knowledge Scale for African American Men. Am J Mens Health 2019; 13:1557988319892459. [PMID: 31849259 PMCID: PMC6920598 DOI: 10.1177/1557988319892459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/07/2019] [Accepted: 11/01/2019] [Indexed: 11/25/2022] Open
Abstract
African American men have the highest prostate cancer-related mortality nationally. In response to this disparity, targeted interventions are emerging to enhance African American men's prostate cancer (PrCA) knowledge to ensure they are equipped to make informed decisions about PrCA screening with health-care providers. African American men's PrCA knowledge has been measured inconsistently over time with limited psychometric evidence. The factor structure of this construct in African American men is relatively unknown. This study describes the development and psychometric evaluation of an 18-item Prostate Cancer Knowledge Scale among 352 African American men. Exploratory factor analysis (EFA) was conducted using weighted least square mean and variance estimation with Geomin rotation. EFA yielded three factors: PrCA Anatomy and Screening (6 items), Risk Factors (5 items), Warning Signs (7 items) with good internal consistency reliability at KR-20 = .80 for the total scale and .64, .66, and .75, respectively, for each subscale. Factor loadings ranged from .31 to .86. The standardized root mean square residual (0.08) indicated that the factor structure explained most of the correlations. The three-factor, 18-item Prostate Cancer Knowledge Scale demonstrates that PrCA knowledge is a multidimensional construct and has utility for reliably measuring PrCA knowledge among African American men. Future research is required to confirm this factor structure among socio-demographically diverse African Americans.
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Affiliation(s)
- Otis L. Owens
- College of Social Work, University of
South Carolina, Columbia, USA
| | | | - Theda Rose
- School of Social Work, University of
Maryland, Baltimore, USA
| | - Nikki R. Wooten
- College of Social Work, University of
South Carolina, Columbia, USA
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10
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Gokce Mİ, Akpınar C, Esen B, Solak V, Gülpınar O, Bedük Y. The role of a novel decision aid to support informed decision making process in patients with a symptomatic non - lower pole renal stone < 20 mm in diameter: a prospective randomized study. Int Braz J Urol 2019; 45:941-947. [PMID: 31268641 PMCID: PMC6844346 DOI: 10.1590/s1677-5538.ibju.2018.0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/28/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the efficacy of a novel decision aid (DA) in improving the patients’ level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone <2 cm. Materials and Methods In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. Results Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. Conclusions In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone <20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.
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Affiliation(s)
- Mehmet İlker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Cağrı Akpınar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Barış Esen
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Vahid Solak
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Omer Gülpınar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yaşar Bedük
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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11
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Assessment of men's risk thresholds to proceed with prostate biopsy for the early detection of prostate cancer. Int Urol Nephrol 2019; 51:1297-1302. [PMID: 31187423 DOI: 10.1007/s11255-019-02196-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To delineate the range of "risk thresholds" for prostate biopsy to determine how improved prostate cancer (CaP) risk prediction tools may impact shared decision-making (SDM). METHODS We conducted a cross-sectional survey study involving men 45-75 years old attending a multispecialty urology clinic. Data included demographics, personal and family prostate cancer history, and prostate biopsy history. Respondents were presented with a summary of the details, risks, and benefits of prostate biopsy, then asked to indicate the specific risk threshold (% chance) of high-grade CaP at which they would proceed with prostate biopsy. RESULTS Of a total of 103 respondents, 18 men (17%) had a personal history of CaP, and 31 (30%) had undergone prostate biopsy. The median risk threshold to proceed with prostate biopsy was 25% (interquartile range 10-50%). Risk thresholds did not vary by race, education, or employment. Personal history of CaP or prostate biopsy was significantly associated with lower mean risk thresholds (19% vs. 32% [P = 0.02] and 23% vs. 33% [P = 0.04], respectively). In the lowest versus highest risk threshold quartiles, there were significantly higher rates of CaP (36% vs. 1%, P = 0.01) and prior prostate biopsy (46% vs. 17%, P < 0.01). CONCLUSIONS Men have a wide range of risk thresholds for high-grade CaP to proceed with prostate biopsy. Men with a prior history of CaP or biopsy reported lower risk thresholds, which may reflect their greater concern for this disease. The extent to which refined risk prediction tools will improve SDM warrants further study.
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12
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Bloom Syndrome Protein Activates AKT and PRAS40 in Prostate Cancer Cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:3685817. [PMID: 31210839 PMCID: PMC6532288 DOI: 10.1155/2019/3685817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/07/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
Abstract
Purpose Prostate cancer (PC) is a common malignant tumor and a leading cause of cancer-related death in men worldwide. In order to design new therapeutic interventions for PC, an understanding of the molecular events underlying PC tumorigenesis is required. Bloom syndrome protein (BLM) is a RecQ-like helicase, which helps maintain genetic stability. BLM dysfunction has been implicated in tumor development, most recently during PC tumorigenesis. However, the molecular basis for BLM-induced PC progression remains poorly characterized. In this study, we investigated whether BLM modulates the phosphorylation of an array of prooncogenic signaling pathways to promote PC progression. Methods We analyzed differentially expressed proteins (DEPs) using iTRAQ technology. Site-directed knockout of BLM in PC-3 prostate cancer cells was performed using CRISPR/Cas9-mediated homologous recombination gene editing to confirm the effects of BLM on DEPs. PathScan® Antibody Array Kits were used to analyze the phosphorylation of nodal proteins in PC tissue. Immunohistochemistry and automated western blot (WES) analyses were used to validate these findings. Results We found that silencing BLM in PC-3 cells significantly reduced their proliferative capacity. In addition, BLM downregulation significantly reduced levels of phosphorylated protein kinase B (AKT (Ser473)) and proline-rich AKT substrate of 40 kDa (PRAS40 (Thr246)), and this was accompanied by enhanced ROS (reactive oxygen species) levels. In addition, we found that AKT and PRAS40 inhibition reduced BLM, increased ROS levels, and induced PC cell apoptosis. Conclusions We demonstrated that BLM activates AKT and PRAS40 to promote PC cell proliferation and survival. We further propose that ROS act in concert with BLM to facilitate PC oncogenesis, potentially via further enhancing AKT signaling and downregulating PTEN expression. Importantly, inhibiting the BLM-AKT-PRAS40 axis induced PC cell apoptosis. Thus, we highlight new avenues for novel anti-PC treatments.
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13
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Cui CX, Li YQ, Sun YJ, Zhu YL, Fang JB, Bai B, Li WJ, Li SZ, Ma YZ, Li X, Wang WH, Jin NY. Antitumor effect of a dual cancer-specific oncolytic adenovirus on prostate cancer PC-3 cells. Urol Oncol 2019; 37:352.e1-352.e18. [PMID: 30665692 DOI: 10.1016/j.urolonc.2018.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/21/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Apoptin can specifically kill cancer cells but has no toxicity to normal cells. Human telomerase reverse transcriptase (hTERT) acts as a tumor-specific promoter, triggering certain genes to replicate or express only in tumor cells, conferring specific replication and killing abilities. This study aimed to investigate the anticancer potential of the recombinant adenovirus Ad-apoptin-hTERTp-E1a (Ad-VT) in prostate cancer. METHODS The pGL4.51 plasmid was used to transfect PC-3 cells to construct tumor cells stably expressing luciferase (PC-3-luc). Crystal violet staining and MTS assays determined the ability of Ad-VT to inhibit cell proliferation. Ad-VT-induced apoptosis of PC-3-luc cells was detected using Hoechst, Annexin V, JC-1 staining, and caspases activity analysis. PC-3-luc cells invasion and migration were detected using cell-scratch and Transwell assays. In vivo tumor inhibition was detected using imaging techniques. RESULTS Crystal violet staining and MTS results showed that the proliferation ability of PC-3-luc cells decreased significantly. Hoechst, JC-1, and Annexin V experiments demonstrated that Ad-VT mainly induced apoptosis to inhibit PC-3-luc cell proliferation. Ad-VT could significantly inhibit the migration and invasion of PC-3-luc cells over a short period of time. In vivo, Ad-VT could effectively inhibit tumor growth and prolong survival of the mice. CONCLUSIONS The recombinant adenovirus, comprising the apoptin protein and the hTERTp promoter, was able to inhibit the growth of prostate cancer PC-3 cells and promote their apoptosis.
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Affiliation(s)
- Chuan-Xin Cui
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China; Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China
| | - Yi-Quan Li
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China
| | - Yu-Jia Sun
- Department of Operating Room, The Second Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Yi-Long Zhu
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China
| | - Jin-Bo Fang
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China
| | - Bing Bai
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China
| | - Wen-Jie Li
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Jiang su Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, P. R. China
| | - Shan-Zhi Li
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China
| | - Yi-Zhen Ma
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Jiang su Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, P. R. China
| | - Xiao Li
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China; Jiang su Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, P. R. China.
| | - Wei-Hua Wang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China; Department of Urology Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.
| | - Ning-Yi Jin
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, P. R. China; Changchun University of Chinese Medicine, Changchun, P. R. China; Jiang su Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, P. R. China.
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Pacyna JE, Radecki Breitkopf C, Jenkins SM, Sutton EJ, Horrow C, Kullo IJ, Sharp RR. Should pretest genetic counselling be required for patients pursuing genomic sequencing? Results from a survey of participants in a large genomic implementation study. J Med Genet 2018; 56:317-324. [PMID: 30580287 DOI: 10.1136/jmedgenet-2018-105577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE We assessed the decision-making of individuals pursuing genomic sequencing without a requirement for pretest genetic counselling. We sought to describe the extent to which individuals who decline genetic counselling reported decisional conflict or struggled to make a decision to pursue genomic testing. METHODS We administered a 100-item survey to 3037 individuals who consented to the Return of Actionable Variants Empirical study, a genomic medicine implementation study supported by the National Institutes of Health (USA) eMERGE consortium. The primary outcomes of interest were self-reported decisional conflict about the decision to participate in the study and time required to reach a decision. RESULTS We received 2895 completed surveys (response rate=95.3%), and of these respondents 97.8% completed the decisional conflict scale in its entirety. A majority of individuals (63%) had minimal or no decisional conflict about the pursuit of genomic sequencing and were able to reach a decision quickly (78%). Multivariable logistic regression analyses identified several characteristics associated with decisional conflict, including lower education, lower health literacy, lower self-efficacy in coping, lack of prior experience with genetic testing, not discussing study participation with a family member or friend, and being male. CONCLUSION As genomic sequencing is used more widely, genetic counselling resources may not be sufficient to meet demand. Our results challenge the notion that all individuals need genetic counselling in order to make an informed decision about genomic sequencing.
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Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sarah M Jenkins
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Horrow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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15
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Weiner AB, Tsai KP, Keeter MK, Victorson DE, Schaeffer EM, Catalona WJ, Kundu SD. The Influence of Decision Aids on Prostate Cancer Screening Preferences: A Randomized Survey Study. J Urol 2018; 200:1048-1055. [PMID: 29852180 PMCID: PMC6203648 DOI: 10.1016/j.juro.2018.05.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Shared decision making is recommended in regard to prostate cancer screening. Decision aids may facilitate this process but the impact of decision aids on screening preferences is poorly understood. MATERIALS AND METHODS In an online survey we randomized a national sample of adults to the online decision aids of 1 of 6 professional societies. We compared survey responses before and after decision aid exposure. The primary outcome was the change in participant likelihood of undergoing or recommending prostate cancer screening on a scale of 1-unlikely to 100-extremely likely. Secondary outcomes included change in participant comfort with prostate cancer screening based on the average of 6, 5-point Likert-scale questions. RESULTS Median age was 53 years in the 1,336 participants and 50% were men. The randomized groups did not differ significantly by race, age, gender, income, marital status or education level. The likelihood of undergoing or recommending prostate cancer screening decreased from 83 to 78 following decision aid exposure (p <0.001). Reviewing the decision aid from the Centers for Disease Control or the American Academy of Family Physicians did not alter the likelihood (each p >0.2). However, the decision aid from the United States Preventive Services Task Force was associated with the largest decrease in screening preference (-16.0, p <0.001). Participants reported increased comfort (from 3.5 to 4.1 of 5) with the decision making process of prostate cancer screening following exposure to a decision aid (p <0.001). CONCLUSIONS Exposure to a decision aid decreased the participant likelihood of undergoing or recommending prostate cancer screening and increased comfort with the screening process.
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Affiliation(s)
- Adam B. Weiner
- Department of Urology, Northwestern University Feinberg
School of Medicine, Chicago, IL
| | - Kyle P. Tsai
- Department of Urology, Northwestern University Feinberg
School of Medicine, Chicago, IL
| | - Mary-Kate Keeter
- Department of Urology, Northwestern University Feinberg
School of Medicine, Chicago, IL
| | - David E. Victorson
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, IL
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg
School of Medicine, Chicago, IL
| | - William J. Catalona
- Department of Urology, Northwestern University Feinberg
School of Medicine, Chicago, IL
| | - Shilajit D. Kundu
- Department of Urology, Northwestern University Feinberg
School of Medicine, Chicago, IL
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Gökce Mİ, Esen B, Sancı A, Akpınar C, Süer E, Gülpınar Ö. A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter. J Endourol 2018; 31:725-728. [PMID: 28467724 DOI: 10.1089/end.2017.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones <20 mm in diameter. MATERIALS AND METHODS The DA development process was established based on the recommended guides. General characteristics of the stone disease and details of the shockwave lithotripsy and retrograde intrarenal surgery were included in the content of the DA. The DA was further revised based on the suggestions of different physician groups and patients. The DA was evaluated by three physicians (Delphi assessment-International Patient Decision Aid Standards [IPDAS] Collaboration standards) and 25 patients (questionnaire of six questions with five-point Likert scale). RESULTS The DA was designed as a booklet, and Delphi group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. CONCLUSIONS This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.
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Affiliation(s)
- Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Barış Esen
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Adem Sancı
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Cağrı Akpınar
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Ömer Gülpınar
- Department of Urology, Ankara University School of Medicine , Ankara, Turkey
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