A pilot study of prostate cancer knowledge among African American men and their health care advocates: implications for screening decisions

Involvement of Reactive Oxygen Species in Prostate Cancer and Its Disparity in African Descendants

Reactive oxygen species (ROS) participate in almost all disorders, including cancer. Many factors, including aging, a high-fat diet, a stressful lifestyle, smoking, infection, genetic mutations, etc., lead to elevated levels of ROS. Prostate cancer, the most prevalent type of cancer in senior American men and the second leading cause of cancer mortality in American men, results from chronic oxidative stress. The doubled incident rate as well as the doubled mortality numbers of prostate cancer have persisted in African Americans in comparison with Caucasian Americans and other racial groups, indicating a prostate cancer disparity in African American men. In this review, we mainly focus on the latest findings on ROS in prostate cancer development and progression within the last five years to update our understanding in this area, as several comprehensive literature reviews addressing oxidative stress and/or inflammation in prostate cancer before 2020 are available. In addition to other known factors such as socioeconomic disadvantage, cultural mistrust of the health care system, etc. that are long-existing in the African American group, we also summarize the latest evidence that demonstrated high systemic oxidative stress and inflammation in African Americans for their potential contribution to the racial prostate cancer disparity in this population.

Racial disparities in Black men with prostate cancer: A literature review

Black men are disproportionately affected by prostate cancer (PCa), with earlier presentation, more aggressive disease, and higher mortality rates versus White men. Furthermore, Black men have less access to PCa treatment and experience longer delays between diagnosis and treatment. In this review, the authors discuss the factors contributing to racial disparities and present solutions to improve access to care and increase clinical trial participation among Black men with PCa. Racial disparities observed among Black men with PCa are multifaceted, evolving from institutional racism. Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on PCa and treatment options, fear of PCa diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time, and cancer debt, play an important role in racial disparities observed in PCa treatment and outcomes. Racial diversity is often lacking in genomic and precision medicine studies. Black men are largely underrepresented in key phase 3 PCa trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams, and bias of health care providers to recommend clinical research. The authors propose solutions to address these factors that include educating clinicians and institutions on the barriers Black men experience, increasing the diversity of health care providers and clinical research teams, and empowering Black men to be involved in their treatment, which are keys to creating equity for Black men with PCa. LAY SUMMARY: Prostate cancer negatively affects Black men more than men of other races. The history of segregation and mistreatment in the health care system may contribute to mistrust among Black men. Outcomes are worse for Black men because they are less likely to be screened or to receive treatment for prostate cancer. Black men also are unlikely to participate in clinical research, making it difficult for investigators to understand how Black men are affected by prostate cancer. Suggestions for addressing these differences include teaching physicians and nurses about the issues Black men experience getting treatment and improving how Black men get information on prostate cancer.

Awareness about prostate cancer and its screening in Medina, Jeddah, and Makkah, Saudi Arabia population

Background:

Prostate cancer (PCa) is a global burden on public health; it has been ranked as the second common cancer worldwide, with 1.3 million new cases in 2018. Developed countries have a higher incidence than in developing countries. Because of the lack of studies on PCa in Saudi Arabia, our study aims to measure the awareness about PCa and knowledge of PCa screening practices among men in Medina, Jeddah, and Makkah, Saudi Arabia.

Methodology:

A cross-sectional study conducted among males in Medina, Jeddah, and Makkah, Saudi Arabia, from 2^nd to 10^th July 2020, using a validated questionnaire. The sample size was 1212 participants. Data collected through an online questionnaire. All data analyses performed using (SPSS) software, using the Chi-square test for bivariate analysis. All levels of significance were set at P < 0.05.

Results:

We collected 1212 completed surveys, with mean ages of 36 years (standard deviation ± 12.77). We found that 77% of participants heard about PCa, and 52.5% heard about PCa screening tests. This study showed that only 10.6% of all participants had good knowledge, 41.9% had fair knowledge, and 47.5% had poor knowledge. Only 3.9% of participants had experienced the prostate-specific antigen test.

Conclusion:

The study showed that the level of knowledge of PCa is low. Thus, community and individuals should collaborate to increase awareness by having more awareness campaigns, disseminating the information through the media, and encouraging men to do screening tests as indicated. In addition, including more Saudi Arabia cities in future studies is preferable to have more precise outcomes.

Knowledge of prostate cancer among African American men: A systematic review

OBJECTIVE

Recent studies indicate that many African American men may not be making informed decisions about prostate cancer early detection. This is partly due to patients having limited knowledge about early detection of the disease.

METHODS

The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles (n = 235) published in English from 1993 through July 31, 2020 were identified using the following MESH search terms and Boolean algebra commands: prostate cancer and knowledge and African Americans.

RESULTS

Forty-two articles were eligible for inclusion. The results of this literature review indicate that many African American men have inadequate knowledge of prostate cancer and prostate cancer early detection. Studies indicate that knowledge of prostate cancer is particularly low among older, less-educated, lower-income, and unmarried men, along with those who lack a regular physician or health insurance. Many African American men are unaware that they are at increased risk of prostate cancer because of their age or race.

CONCLUSIONS

Culturally appropriate educational efforts are needed to inform African- American men about the pros and cons of prostate cancer early detection and about risk factors for the disease so that they can make an informed decision about whether prostate cancer early detection is right for them. Of particular concern is the prostate cancer knowledge of low-income and less-educated men, along with those who lack health care insurance or a regular provider.

Prostate cancer screening in Black men: Screening intention, knowledge, attitudes, and reasons for participation

The objective of the present study is to capture the prostate cancer screening intention, knowledge levels, attitudes, and reasons for participation in screening among African American men. African American men aged from 35 to 65 in Georgia, North Carolina, and Ohio were recruited for study (N = 168). Questionnaires were administered using validated instruments. Findings suggest critical needs for community-based social workers to communicate the importance of prostate cancer screening and risk factors among African American men. Increasing the use of culturally relevant community health education might benefit underserved minority men at risk of having prostate cancer.

Factors influencing chemotherapy knowledge in women with breast cancer

BACKGROUND

Chemotherapy knowledge is linked to managing side effects, reducing exposure to potential infection, and adjusting lifestyle behaviors while going through treatment. However, no research exists regarding the influence of patients' personal attributes on chemotherapy knowledge. Aim The aim of this study was to describe the relationships of health literacy and demographics on chemotherapy knowledge among women with breast cancer undergoing treatment.

METHOD

We used a descriptive, exploratory design with convenience sampling of women with breast cancer receiving intravenous chemotherapy who completed one mandatory education session. Participants completed a demographic questionnaire and three instruments: 1) Rapid Estimate of Adult Literacy - Short Form (REALM-SF); 2) Shortened Test of Functional Health Literacy in Adults (S-TOFHLA); and 3) Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC). We used univariate linear regression and ANOVA to identify how health literacy and demographics influenced chemotherapy knowledge.

RESULTS

The REALM-SF (p = .022) and S-TOFHLA (p = .023) scores were significantly associated with chemotherapy knowledge. Chemotherapy knowledge scores were affected by marital status (p = .018) and income (p < .001) where married women had significantly higher chemotherapy knowledge scores (M = 92.6, SD = 6.6) than women who were divorced (M = 83.3, SD = 16.7) with a knowledge score difference of -9.3 between the groups (p = .02). Comparisons showed significant differences of chemotherapy knowledge between women with differing income levels.

CONCLUSIONS

This study highlights the relevance of considering patients' health literacy and personal attributes such as marital status and income when teaching about chemotherapy.

An Exploration of Precancer and Post-Cancer Diagnosis and Health Communication Among African American Prostate Cancer Survivors and Their Families

Prostate cancer is the second most common cancer among American men, with Black men at the highest risk for the disease. Few studies have been published on how communication between Black prostate cancer survivors and their family members affect health outcomes and subsequent health communication. The purpose of this study was to understand cancer and health communication among Black prostate cancer survivors and their families before and after disclosing their diagnosis. Through a mixed method design, 11 Black prostate cancer survivors participated from the Southeastern region of the United States, completed questionnaires, and took part in a focus group. The study utilized 4 focus groups of Black prostate cancer survivors ranging in age from 51 to 76 years. Descriptive statistics revealed 91% (n = 10) of participants indicated they could openly discuss health issues in their family and 82% (n = 9) indicated a female relative as the person responsible for teaching about health. An analysis of the transcripts revealed four themes utilizing thematic network: (a) communication over the life course of the prostate cancer survivor, (b) parents’ communication with family, (c) disclosing prostate cancer diagnosis, and (d) treatment options for prostate cancer. Results suggested the participants recognized the importance of discussing prostate cancer with their families to reduce fears and misconceptions about the disease. Through the exploration of cancer and health communication within Black families, solutions can be derived for increasing health behaviors and health knowledge among men.

Improvement of Knowledge, Attitudes, and Beliefs of African American Men Toward Prostate Cancer Screening

BACKGROUND

Prostate cancer (PCa) is a major public health concern among African American (A.A.) men. A.A. men have the highest PCa incidences nationally and internationally.

OBJECTIVE

The goal of this pilot study was to evaluate the effectiveness of an evidence-based PCa awareness intervention designed to positively affect the knowledge, attitudes, and beliefs of A.A. men regarding PCa screening.

METHOD

A quantitative pre/post survey research design was utilized. A convenience sample of 11 subjects were recruited. The intervention consisted of a pre-survey, video presentation, oral presentation, question and answer session, and post-survey. The Thomas Jefferson University Prostate Cancer Screening Survey was used as the survey instrument.

RESULTS

The findings revealed a strong positive correlation between age of participants and pre-test scores. As education level increased among the participants so did knowledge, attitudes, and beliefs.

CONCLUSIONS

The study's goal was met by increasing awareness and changing knowledge, attitudes, and beliefs in A.A. men regarding PCa screening.

IMPLICATIONS FOR NURSING

Nurses and healthcare providers should encourage discussions with A.A. men regarding advantages and disadvantages of PCa screening that embraces cultural awareness. PCa knowledge is important for shared decision-making with healthcare providers.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity

BACKGROUND AND OBJECTIVES

This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development.

RESEARCH DESIGN AND METHODS

Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138).

RESULTS

Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91).

DISCUSSION AND IMPLICATIONS

PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.