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Pekala KR, Shill DK, Austria M, Langford AT, Loeb S, Carlsson SV. Shared decision-making before prostate cancer screening decisions. Nat Rev Urol 2024; 21:329-338. [PMID: 38168921 PMCID: PMC11250989 DOI: 10.1038/s41585-023-00840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.
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Affiliation(s)
- Kelly R Pekala
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mia Austria
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aisha T Langford
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stacy Loeb
- Department of Population Health, New York University, New York, NY, USA
- Department of Urology, New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden.
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2
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Mumuni S, O’Donnell C, Doody O. The Risk Factors and Screening Uptake for Prostate Cancer: A Scoping Review. Healthcare (Basel) 2023; 11:2780. [PMID: 37893854 PMCID: PMC10606491 DOI: 10.3390/healthcare11202780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES The purpose of this scoping review was to identify the risk factors and screening uptake for prostate cancer. DESIGN Scoping review. METHODS Arksey and O'Malley's framework guided this review; five databases (Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Academic Search Complete and Cochrane Library) and grey literature were searched. Screening was undertaken against predetermined inclusion criteria for articles published before July 2023 and written in English. This review is reported in line with PRISMA-Sc. RESULTS 10,899 database results were identified; 3676 papers were removed as duplicates and 7115 papers were excluded at title and abstract review. A total of 108 papers were full-text reviewed and 67 were included in the review. Grey literature searching yielded no results. Age, family history/genetics, hormones, race/ethnicity, exposure to hazards, geographical location and diet were identified as risk factors. Prostatic antigen test (PSA), digital rectal examination (DRE), transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), magnetic resonance spectroscopic imaging (MRSI) and prostate biopsy were identified as screening/diagnostic methods. The evidence reviewed highlights moderate knowledge and screening uptake of prostate cancer with less than half of men reporting for PSA screening. On the other hand, there is a year-to-year increase in PSA and DRE screening, but factors such as poverty, religion, culture, communication barriers, language and costs affect men's uptake of prostate cancer screening. CONCLUSION As prostate cancer rates increase globally, there is a need for greater uptake of prostate cancer screening and improved health literacy among men and health workers. There is a need to develop a comprehensive prostate cancer awareness and screening programme that targets men and addresses uptake issues so as to provide safe, quality care. STRENGTHS AND LIMITATIONS OF THIS STUDY (1) A broad search strategy was utilised incorporating both databases and grey literature. (2) The PRISMA reporting guidelines were utilised. (3) Only English language papers were included, and this may have resulted in relevant articles being omitted.
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Affiliation(s)
- Seidu Mumuni
- Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland; (S.M.); (C.O.)
| | - Claire O’Donnell
- Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland; (S.M.); (C.O.)
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, V94 T9PX Limerick, Ireland
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3
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Alford NA, Wongpaiboon M, Luque JS, Harris CM, Tawk RH. Associations of Content and Context of Communication with Prostate-Specific Antigen Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5721. [PMID: 37174239 PMCID: PMC10177781 DOI: 10.3390/ijerph20095721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
There is limited research about the content and context of communication on prostate-specific antigen (PSA) testing among men in the state of Florida. The purpose of this study is to understand how the content communication (discussion of advantages and disadvantages of PSA testing between provider and patient; provider recommendations of PSA testing) and the context of communication (continuity of care denoted by the presence of a personal doctor) influence PSA testing. Data were drawn from the Florida Behavioral Risk Factor Surveillance System. Receipt of PSA testing was the primary outcome. Multiple logistic regression analyses were used to adjust for sociodemographic, clinical, healthcare access, and lifestyle characteristics when associating the content and context of communication with PSA testing. Discussions were classified into four mutually exclusive categories: discussions of advantages and disadvantages, only advantages, only disadvantages, and no discussion. The most significant predictors for PSA testing included physician recommendation, discussions including advantages, older age, non-smoking, and having a personal doctor. Individualized PSA screening may be a pathway to reducing racial disparities in screening for prostate cancer (PCa) and, by extension, lower incidence and mortality rates. Developing a bill to create an Office of Men's Health at Health & Human Services is recommended.
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Affiliation(s)
- Nicholas A. Alford
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | | | - John S. Luque
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | - Cynthia M. Harris
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | - Rima H. Tawk
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
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4
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Nyame YA, Cooperberg MR, Cumberbatch MG, Eggener SE, Etzioni R, Gomez SL, Haiman C, Huang F, Lee CT, Litwin MS, Lyratzopoulos G, Mohler JL, Murphy AB, Pettaway C, Powell IJ, Sasieni P, Schaeffer EM, Shariat SF, Gore JL. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol 2022; 82:341-351. [PMID: 35367082 DOI: 10.1016/j.eururo.2022.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes. OBJECTIVE To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions. EVIDENCE ACQUISITION A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes. EVIDENCE SYNTHESIS Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men. CONCLUSIONS Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes. PATIENT SUMMARY Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
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Affiliation(s)
- Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA
| | - Franklin Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Isaac J Powell
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Peter Sasieni
- Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Ebbesen M, Sørensen KD, Pedersen BG, Andersen S. Ethical Principles in the Analysis of Prostate Cancer Diagnostics. Cancer Invest 2022; 40:799-810. [PMID: 35787090 DOI: 10.1080/07357907.2022.2098314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Recent developments in prostate cancer diagnostics call for appropriate tools to frame the ethical assessment of diagnostic practice. The first aim is to identify ethically important features and ethical principles of key importance for prostate cancer diagnostics. Next, we need to argue which ethical theory justifies these principles and can therefore be used for ethical assessment in the field. The standard medical procedure for prostate cancer diagnostics offered by the Danish health care system is used as an example.
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Affiliation(s)
- Mette Ebbesen
- Department of Molecular Medicine, Aarhus University Hospital & Centre for Science Studies, Department of Mathematics, Aarhus University, Denmark. ORCID: 0000-0002-1453-1449
| | - Karina Dalsgaard Sørensen
- Department of Molecular Medicine, Aarhus University Hospital & Department of Clinical Medicine, Aarhus University, Denmark. ORCID: 0000-0002-4902-5490
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital & Department of Clinical Medicine, Aarhus University, Denmark. ORCID: 0000-0003-2792-7343
| | - Svend Andersen
- School of Culture and Society, Aarhus University, Denmark. ORCID: 0000-0002-2295-0571
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6
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Malika N, Roberts L, Alemi Q, Casiano CA, Montgomery S. Ethnic Differences Among Black Men in Prostate Cancer Knowledge and Screening: a Mixed-Methods Study. J Racial Ethn Health Disparities 2022; 9:874-885. [PMID: 33783757 DOI: 10.1007/s40615-021-01027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Black men are disproportionately affected by prostate cancer (PCa) incidence and mortality. Limited research has been reported on the ethnic differences among Black men in regard to family history, knowledge, and screening habits. Thus, this study was conducted to understand and compare knowledge levels and family history of the three main Black subgroups (African Americans, Caribbean immigrants, and African immigrants) in the USA and to assess the influence of knowledge on past screening behavior and intentionality for screening in the future for PCa. A concurrent mixed-methods design was used with participants (N = 396) recruited from different parts of the country. The grounded theory method of analysis was used for qualitative data and a logistic regression was used to explain the relationship between screening intentionality and PCa knowledge and family history. Qualitative results indicated that subjective PCa knowledge between the three subgroups was relatively similar but differed based on whether a person knew a family member or friend who had been affected by the disease. Themes focused on risk, PCa education, screening, and impact on sexuality. Quantitatively, result revealed that there are ethnic differences in knowledge across the three subgroups. Additionally, regression results revealed that family history is a stronger predictor of screening behavior and intentionality than knowledge. This study was able to unveil a deeper understanding on the role of family history and knowledge on PCa among Black subgroups.
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Affiliation(s)
- Nipher Malika
- Loma Linda University School of Behavioral Health, 11065 Campus St, Loma Linda, CA, 92350, USA.
- Institute for Community Partnerships, Loma Linda University, 11188 Anderson Street, Loma Linda, CA, 92350, USA.
| | - Lisa Roberts
- Loma Linda University School of Nursing, 11262 Campus Street, West Hall, Loma Linda, CA, 92350, USA
| | - Qais Alemi
- Loma Linda University School of Behavioral Health, 11065 Campus St, Loma Linda, CA, 92350, USA
| | - Carlos A Casiano
- Center for Health Disparities and Molecular Medicine, Departments of Basic Sciences and Medicine, Loma Linda University School of Medicine, Mortensen Hall, 11085 Campus Street, Loma Linda, CA, 92350, USA
| | - Susanne Montgomery
- Loma Linda University School of Behavioral Health, 11065 Campus St, Loma Linda, CA, 92350, USA
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7
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Matthews AK, Murray M, Ben Levi J, Odell D, Jeremiah R, Moore L, Oyaluade D, Chappel A, Burke L, Watson K. Preliminary Evaluation of a Citizen Scientist Educational Curriculum Aimed at Engaging Black Men in Lung Cancer Early Detection Screening. Am J Mens Health 2022; 16:15579883221099417. [PMID: 35694882 PMCID: PMC9201322 DOI: 10.1177/15579883221099417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
This article describes an educational program to engage African American men as citizen scientists (CSs) and future research partners in a lung cancer screening project. We provide an overview of the curriculum used, the structure and format of the educational sessions, and associated educational outcomes. Furthermore, we describe lessons learned in the engagement of African American men as CS in community-based lung-health equity research. The CS educational program included five group-based sessions delivered through zoom. The educational curriculum was adapted from the University of Florida Citizen Scientist program and tailored to address lung health and the contextual experiences of African American men. Each session lasted 90 minutes. Pre- and post-test measures were collected to examine changes in knowledge, comfort, health literacy, research interests, and medical mistrust. Eight African American men completed the CS educational program. Attendance rates were high for each session (100%). Seven participants completed additional human subject research certification. Improvements were observed from pre- to post-test in participants' level of knowledge, comfort, and health literacy but not medical mistrust. CS reported the most interest in participating in research aimed to identify important community strengths and problems. Study findings suggest that it was feasible to deliver an online citizen scientist educational program designed to prepare participants to serve as partners in a lung cancer screening intervention for African American men. Results suggest the educational program has the potential to improve key outcomes including completion of regulatory training and increased research-related knowledge, comfort, and health literacy.
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Affiliation(s)
- Alicia K. Matthews
- College of Nursing, The University of
Illinois at Chicago, Chicago, IL, USA
| | | | - Josef Ben Levi
- College of Education, Northeastern
Illinois University, Chicago, IL, USA
| | - David Odell
- Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Rohan Jeremiah
- College of Nursing, The University of
Illinois at Chicago, Chicago, IL, USA
| | | | - Damilola Oyaluade
- Cancer Center, The University of
Illinois at Chicago, Chicago, IL, USA
| | - Alexis Chappel
- College of Education, Northeastern
Illinois University, Chicago, IL, USA
| | - Larisa Burke
- College of Nursing, The University of
Illinois at Chicago, Chicago, IL, USA
| | - Karriem Watson
- School of Public Health, The University
of Illinois at Chicago, Chicago, IL, USA
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8
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DeRosa AP, Grell Y, Razon D, Komsany A, Pinheiro LC, Martinez J, Phillips E. Decision-making support among racial and ethnic minorities diagnosed with breast or prostate cancer: A systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2022; 105:1057-1065. [PMID: 34538465 DOI: 10.1016/j.pec.2021.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/01/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the types of decision-making support interventions offered to racial and ethnic minority adults diagnosed with breast or prostate cancer and to draw any associations between these interventions and patient-reported quality of life (QoL) outcomes. METHODS We conducted literature searches in five bibliographic databases. Studies were screened through independent review and assessed for quality. Results were analyzed using inductive qualitative methods to determine thematic commonalities and synthesized in narrative form. RESULTS Searches across five databases yielded 2496 records, which were screened by title/abstract and full-text to identify 10 studies meeting inclusion criteria. The use of decision aids (DAs), trained personnel, delivery models and frameworks, and educational materials were notable decision-making support interventions. Analysis revealed six thematic areas: 1) Personalized reports; 2) Effective communication; 3) Involvement in decision-making; 4) Health literacy; 5) Social support; and 6) Feasibility in clinical setting. CONCLUSION Evidence suggests decision-making support interventions are associated with positive outcomes of racial and ethnic minorities with patient-reported factors like improved patient engagement, less decisional regret, higher satisfaction, improved communication, awareness of health literacy and cultural competence. PRACTICE IMPLICATIONS Future decision-making interventions for racial and ethnic minority cancer patients should focus on social determinants of health, social support systems, and clinical outcomes like QoL and survival.
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Affiliation(s)
- Antonio P DeRosa
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, USA.
| | | | - Dominic Razon
- Division of General Internal Medicine, Weill Cornell Medicine, New York, USA
| | - Alia Komsany
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
| | - Laura C Pinheiro
- Division of General Internal Medicine, Weill Cornell Medicine, New York, USA
| | - Juana Martinez
- Division of General Internal Medicine, Weill Cornell Medicine, New York, USA
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, New York, USA
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9
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Srinivasan B, Nanus DM, Erickson D, Mehta S. Highly portable quantitative screening test for prostate-specific antigen at point of care. CURRENT RESEARCH IN BIOTECHNOLOGY 2022; 3:288-299. [PMID: 35083431 PMCID: PMC8789004 DOI: 10.1016/j.crbiot.2021.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Prostate cancer (PCa) is the second most diagnosed cancer among men. Targeted PCa screening may decrease PCa-specific mortality. Prostate-specific antigen (PSA) is the most reliable and widely accepted tumor biomarker for screening and monitoring PCa status. However, in many settings, quantification of serum PSA requires access to centralized laboratories. In this study, we describe a proof-of-concept rapid test combined with a highly portable Cube™ reader for quantification of total PSA from a drop of serum within 20 min. We demonstrated the application of gold nanoshells as a label for lateral flow assay with significant increase in the measured colorimetric signal intensity to achieve five times lower detection limit when compared to the traditionally used 40 nm gold nanosphere labels, without a need for any additional signal amplification steps. We first optimized and evaluated the performance of the assay with commercially available total PSA calibrators. For initial validation with commercially available ACCESS Hybritech PSA calibrator, a detection range of 0.5-150 ng/mL was achieved. We compared the performance of our total PSA test with IMMULITE analyzer for quantification of total PSA in archived human serum samples. On preliminary testing with archived serums samples and comparison with IMMULITE total PSA assay, a correlation of 0.95 (p < .0001) was observed. The highly portable quantitative screening test for PSA described in this study has the potential to make PCa screening more accessible where diagnostic labs and automated immunoassay systems are not available, to reduce therapeutic turnaround time, to streamline clinical care, and to direct patient care for both initial screening and for post-treatment monitoring of patients.
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Affiliation(s)
- Balaji Srinivasan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Ithaca, NY, USA
| | - David M Nanus
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David Erickson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Ithaca, NY, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Ithaca, NY, USA
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10
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Qiao EM, Lynch JA, Lee KM, Kotha NV, Nalawade V, Voora RS, Qian AS, Nelson TJ, Yamoah K, Garraway IP, Stewart TF, Parsons JK, Rose BS. Evaluating Prostate-Specific Antigen Screening for Young African American Men With Cancer. J Natl Cancer Inst 2021; 114:592-599. [PMID: 34893859 PMCID: PMC9002290 DOI: 10.1093/jnci/djab221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/02/2021] [Accepted: 11/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients. METHODS We identified African American men aged 40-55 years, diagnosed with prostate cancer between 2004 and 2017 within the Veterans Health Administration. Inverse probability of treatment-weighted propensity scores were used in multivariable models to assess PSA screening on PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on prostate cancer-specific mortality (PCSM), with noncancer death as competing events. All statistical tests were 2-sided. RESULTS The cohort included 4726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1057 (22.4%) with no PSA screening prior to diagnosis. Compared with no screening, PSA screening was associated with statistically significantly reduced odds of PSA levels higher than 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49 to 0.63; P < .001), Gleason score of 8 or higher (OR = 0.78, 95% CI = 0.69 to 0.88; P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39 to 0.64; P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36 to 0.76; P < .001). Primary care provider visits displayed similar effects. CONCLUSIONS Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.
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Affiliation(s)
- Edmund M Qiao
- Veterans Affairs San Diego Health Care System, La Jolla, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Julie A Lynch
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Kyung M Lee
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Nikhil V Kotha
- Veterans Affairs San Diego Health Care System, La Jolla, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Vinit Nalawade
- Veterans Affairs San Diego Health Care System, La Jolla, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Rohith S Voora
- Veterans Affairs San Diego Health Care System, La Jolla, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Alexander S Qian
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Tyler J Nelson
- Veterans Affairs San Diego Health Care System, La Jolla, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Isla P Garraway
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Tyler F Stewart
- Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, La Jolla, CA, USA
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Brent S Rose
- Correspondence to: Brent S. Rose, MD, Department of Radiation Medicine and Applied Sciences, University of California, 3960 Health Sciences Drive, La Jolla, San Diego, CA 92093-0865, USA (e-mail: )
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11
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Johnson JR, Woods-Burnham L, Hooker SE, Batai K, Kittles RA. Genetic Contributions to Prostate Cancer Disparities in Men of West African Descent. Front Oncol 2021; 11:770500. [PMID: 34820334 PMCID: PMC8606679 DOI: 10.3389/fonc.2021.770500] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/01/2021] [Indexed: 12/11/2022] Open
Abstract
Prostate cancer (PCa) is the second most frequently diagnosed malignancy and the second leading cause of death in men worldwide, after adjusting for age. According to the International Agency for Research on Cancer, continents such as North America and Europe report higher incidence of PCa; however, mortality rates are highest among men of African ancestry in the western, southern, and central regions of Africa and the Caribbean. The American Cancer Society reports, African Americans (AAs), in the United States, have a 1.7 increased incidence and 2.4 times higher mortality rate, compared to European American's (EAs). Hence, early population history in west Africa and the subsequent African Diaspora may play an important role in understanding the global disproportionate burden of PCa shared among Africans and other men of African descent. Nonetheless, disparities involved in diagnosis, treatment, and survival of PCa patients has also been correlated to socioeconomic status, education and access to healthcare. Although recent studies suggest equal PCa treatments yield equal outcomes among patients, data illuminates an unsettling reality of disparities in treatment and care in both, developed and developing countries, especially for men of African descent. Yet, even after adjusting for the effects of the aforementioned factors; racial disparities in mortality rates remain significant. This suggests that molecular and genomic factors may account for much of PCa disparities.
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Affiliation(s)
- Jabril R. Johnson
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Leanne Woods-Burnham
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Stanley E. Hooker
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ, United States
| | - Rick A. Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
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12
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Boustany J, Abdessater M, Akl H, Kanbar A, Khoury JE, Assaf S, Dabal C, El Hachem C, Kassis A, Saad R, Halabi R, El Khoury R. Prostate Cancer awareness in the Lebanese population: a cross sectional national survey. BMC Public Health 2021; 21:1744. [PMID: 34563148 PMCID: PMC8466637 DOI: 10.1186/s12889-021-11821-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/14/2021] [Indexed: 12/09/2022] Open
Abstract
Background Prostate cancer (Pca) is the second most common cause of cancer among Lebanese men. Screening is an effective method to reduce prostate cancer mortality. This study assessed the knowledge, awareness, and screening practices among Lebanese population regarding Pca. Methods A cross-sectional national study over all the Lebanese governorates on 1558 persons was undergone. Information on Pca knowledge and attitudes towards screening was obtained using a semi structured questionnaire. Bivariate and binary logistic regression were used to assess relations between Pca knowledge and socio-demographic characteristics. Results The sample consisted of 1088 (69.8%) males and 470 (30.2%) females, with a mean age of 40 Y.O. Concerning early detection methods of Pca, its frequency, the ideal screening age, symptoms and curability of Pca, a significant difference (p < 0.05) was found when studying the following variables: the educational level (university level group having the highest percentage of correct answers), the individual monthly income (more correct answers were found with higher monthly income) and the age groups (most correct answers in the younger age groups). Conclusion Our study points to the need of developing Pca prevention and education programs that should especially target older men, and people of low socioeconomic status and education in Lebanon. Such programs would increase awareness to Pca and screening, ultimately reducing the burden of advanced cancer through its early diagnosis.
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Affiliation(s)
- Johnny Boustany
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Maher Abdessater
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon. .,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon.
| | - Halim Akl
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Anthony Kanbar
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Joey El Khoury
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Serge Assaf
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Charbel Dabal
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Charbel El Hachem
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Antoine Kassis
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Rodrigue Saad
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Rami Halabi
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Raghid El Khoury
- Urology department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.,School of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
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13
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Coughlin SS, Ayyala DN, Moore JX, Majeed BA, Vernon MM, Dergaga H, Luque JS. A Health Survey of African American Men Seen at an Academic Medical Center in the Southern United States. JOURNAL OF COMMUNITY MEDICINE (RENO, NEV.) 2021; 4:1036. [PMID: 34589710 PMCID: PMC8478342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND African Americans have poorer cardiovascular health and higher chronic disease mortality than non-Hispanic whites. The high burden of chronic diseases among African Americans is a primary cause of disparities in life expectancy between African Americans and whites. METHODS We conducted a cross-sectional study via a postal survey among a sample of 65 male, African American patients aged ≥ 40 years. The overall objective was to examine the frequency of high blood pressure, high cholesterol, diabetes, myocardial infarction, congestive heart failure, stroke, asthma, emphysema, and cancer among patients treated at Augusta University Health. RESULTS A high percentage of study participants (81.5 %) reported a history of high blood pressure; 50.8% had high cholesterol; 44.3% were overweight, 44.3% were obese, and 13.9% were current cigarette smokers. About 36.9% of the men had a reported history of diabetes; 10.8% of the men had a history of heart attack, 13.9% had a history of congestive heart failure, 9.2% had a history of stroke, and 15.4% had a history of prostate cancer. Men who reported a personal history of prostate cancer were significantly more likely to have a history of heart attack and stroke and to be overweight (p < 0.05 in each instance). DISCUSSION Additional studies are needed of cardiovascular risk factors and adverse cardiovascular events among African American men, and interventional research aimed at controlling hypertension. Of particular concern is prostate cancer, and whether patients with hypertension, hypercholesterolemia, and diabetes are receiving appropriate therapy to reduce their cardiovascular risk and prevent morbidity and mortality from adverse cardiovascular events.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Deepak Nag Ayyala
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
| | - Justin Xavier Moore
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Ban A Majeed
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Marlo M Vernon
- Department of Medicine, Augusta University, Augusta, GA
- Georgia Cancer Center, Augusta University, Augusta, GA
| | - Hayat Dergaga
- Department of Psychology, Augusta University, Augusta, GA
| | - John S Luque
- Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL
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14
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Coughlin SS, Ayyala DN, Luque JS, Moore JX. Predictors of prostate cancer screening among African American men treated at an Academic Medical Center in the Southern United States. CURRENT CANCER REPORTS 2021; 3:81-94. [PMID: 33898998 PMCID: PMC8064558 DOI: 10.25082/ccr.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The controversy surrounding prostate cancer screening, coupled with the high rates of incidence and mortality among African American men, increase the importance of African American men engaging in an informed decision-making process around prostate cancer screening. PURPOSE To examine predictors of prostate cancer screening via the prostate-specific antigen (PSA) test. Secondary objectives were to examine whether African American men have been screened for prostate cancer; their confidence in making an informed choice about whether PSA testing is right for them; and whether they have talked with their provider about PSA testing and engaged in an informed decision-making process around prostate cancer screening. METHODS We conducted a study among a sample of African American men patients ages ≥ 40 years. RESULTS A total of 65 men completed the questionnaire (response rate = 6.5%). The mean age of the men was 64.4 years. Most of the participants (90.8%) reported a regular healthcare provider and that their provider had discussed the PSA test with them (81.3%). About 84.1% of the men ever had a PSA test, but only 38.0% had one in the past year. Most of the men reported that they make the final decision about whether to have a PSA test on their own (36.5%) or after seriously considering their doctor's opinion (28.6%). About 31.8% of the men reported that they share responsibility about whether to have a PSA test with their doctor. About half of the participants (49.2%) reported that they have made a decision about whether to have a PSA test and they are not likely to change their mind. The majority of the men (75%) perceived their risk of prostate cancer to be about the same level of risk as other men who were their age. The men's knowledge of prostate cancer was fair to good (mean prostate cancer knowledge scale = 10.37, SD 1.87). Knowledge of prostate cancer was positively associated with receipt of a PSA test (p < 0.0206). DISCUSSION The modest overall prostate cancer knowledge among these participants, including their risk for prostate cancer, indicates a need for prostate cancer educational interventions in this patient population.
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Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Deepak Nag Ayyala
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - John S. Luque
- Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL USA
| | - Justin Xavier Moore
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
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15
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Cunningham-Erves J, Campbell L, Barlow C, Barajas C, Mayo-Gamble T, Perry M, Johnson G. Reducing HPV Associated Cancers and Disparities: Engaging African American Men to Develop a Culturally-Appropriate Program that Addresses their Needs. AMERICAN JOURNAL OF HEALTH EDUCATION 2021; 52:194-206. [PMID: 34239655 DOI: 10.1080/19325037.2021.1930614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background The Healthy Men, Health Communities program aims to improve preventive behaviors among African American men to reduce HPV-related cancer disparities. Purpose We describe the development of an educational intervention using cultural-targeting strategies (i.e., linguistics, peripherals, evidence, socio-culture, and constituent-involving). Methods After building capacity of community-based organization (CBO) leaders as research team members, we conducted 3 focus groups, 30 surveys, and a community review and program evaluation with African American men. Results Focus group themes were: 1) The Known and Unknown of Cancer, HPV, and the vaccine; (2) Personal experiences with cancer were commonplace; (3) Barriers to Engaging HPV Cancer Preventive Behaviors; (4) Multi-Modal Strategies are needed to improve preventive behaviors; and (5) Actual versus Preferred Sources of Information. Survey data indicated men desired information on penile (52%) and oral cancers (48%). The preferred education format was a summit with speakers on various topics (96%). Post-summit evaluation indicated majority of males intended to get screened (73%), eat healthier (77%), and exercise more (64%). About 40% reported getting themselves, children, or grandchildren the HPV vaccine. Discussion Our program demonstrated acceptability, feasibility, and preliminary efficacy. This work warrants further study as a potential program to improve HPV preventive behaviors among African American men.
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Affiliation(s)
- Jennifer Cunningham-Erves
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, Tennessee, 37208-3599, United States
| | - Lanese Campbell
- Second Missionary Baptist Cooperative Ministries, 1000 Halcyon Ave, Nashville, Tennessee, 37204, United States
| | - Calvin Barlow
- Second Missionary Baptist Cooperative Ministries, 1000 Halcyon Ave, Nashville, Tennessee, 37204, United States
| | - Claudia Barajas
- Vanderbilt Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, Tennessee, 37232
| | - Tilicia Mayo-Gamble
- Department Community Health Behavior and Education, Georgia Southern University, P.O. Box 8015, 501 Forest Drive, Statesboro, GA, 30460, United States
| | - Michel Perry
- Tennessee Department of Health, 665 Mainstream Drive, Nashville, Tennessee 37243, United States
| | - George Johnson
- School of Graduate Studies and Research, Meharry Medical College, Nashville, Tennessee 37208-3599, United States
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16
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Coughlin SS, Vernon M, Klaassen Z, Tingen MS, Cortes JE. Knowledge of prostate cancer among African American men: A systematic review. Prostate 2021; 81:202-213. [PMID: 33368465 DOI: 10.1002/pros.24097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA
| | - Marlo Vernon
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Zachary Klaassen
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Martha S Tingen
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
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17
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Miller DB, Hamler TC, Qin W. Prostate cancer screening in Black men: Screening intention, knowledge, attitudes, and reasons for participation. SOCIAL WORK IN HEALTH CARE 2020; 59:543-556. [PMID: 32804046 DOI: 10.1080/00981389.2020.1808149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- David B Miller
- Jack,Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - Tyrone C Hamler
- Jack,Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, Ohio, USA
| | - Weidi Qin
- Jack,Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland, Ohio, USA
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18
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Allen JD, Filson CP, Berry DL. Effect of a Prostate Cancer Screening Decision Aid for African-American Men in Primary Care Settings. Cancer Epidemiol Biomarkers Prev 2020; 29:2157-2164. [PMID: 32855264 DOI: 10.1158/1055-9965.epi-20-0454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/22/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND African-American men have an elevated risk of developing and dying from prostate cancer. Shared decision-making (SDM) about prostate cancer screening is recommended but does not always occur. METHODS We pilot-tested an online decision aid (DA) in primary care settings using a pre/postevaluation design among African-American men ages 45 to 70 years. Men completed surveys before and after using the DA, which had interactive segments (e.g., values clarification) and provided individualized assessment of prostate cancer risk. Primary outcomes included prostate cancer knowledge, confidence in ability to make informed decisions, decisional conflict, and satisfaction with the decision. Immediately after the clinical visit, patients reported the degree to which they were engaged by their provider in SDM. RESULTS Among this sample of men (n = 49), use of the DA was associated with increased knowledge about prostate cancer [mean = 55.3% vs. 71.2%; 95% confidence interval (CI), 9.8-22.1; P < 0.001], reduced decisional conflict (mean = 33.4 vs. 23.6; 95% CI, -18.1 to -1.6; P = 0.002) on a scale from 0 to 100, and a decreased preference to be screened (88% vs. 69%; 95% CI, 0.09-0.64; P = 0.01). Most (89%) reported that the DA prepared them well/very well for SDM with their provider. Following the clinical visit with providers, scores on perceived involvement in SDM were 68.1 (SD 29.1) on a 0 to 100 scale. CONCLUSIONS The DA improved men's knowledge, reduced decisional conflict, and promoted the perception of being prepared for SDM. IMPACT Findings suggest that use of an online DA to improve SDM outcomes warrants further testing in a future trial.
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Affiliation(s)
- Jennifer D Allen
- Department of Community Health, Tufts University, Medford, Massachusetts.
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia; Department of Surgical Services, Atlanta VA Medical Center, Atlanta, Georgia
| | - Donna L Berry
- Department of Behavioral Nursing and Health Informatics, University of Washington, School of Nursing, Seattle, Washington
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19
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Langford AT, Scherer LD, Ubel PA, Holmes-Rovner M, Scherr KA, Fagerlin A. Racial differences in veterans' response to a standard vs. patient-centered decision aid for prostate cancer: Implications for decision making in African American and White men. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30322-0. [PMID: 32591257 DOI: 10.1016/j.pec.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine whether racial differences exist in patient preferences for prostate cancer treatment after being informed about options using a patient-centered vs. a standard decision aid (DA). METHODS This article reports secondary analyses of a large study of men diagnosed with early stage prostate cancer. Men were recruited from 4 VA Health Systems and randomized to receive a patient-centered or standard DA about prostate cancer treatment options. Data were collected at 1) baseline, 2) after reading the DA but prior to diagnosis, and 3) after receiving a cancer diagnosis and meeting with a urologist. RESULTS White patients who received the patient-centered DA written at a 7th grade reading level were more likely to prefer active surveillance and less likely to prefer radiation compared to those who received the standard DA written at >9th grade reading level. African American patients' treatment preferences did not differ as a function of DA. CONCLUSIONS When informed about prostate cancer treatment options through a patient-centered DA, White patients changed their treatment preferences but African American patients did not. PRACTICE IMPLICATIONS As DAs are increasingly being used in clinical practice, more research is needed regarding the efficacy, relevance, and receptivity of DAs for African Americans.
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Affiliation(s)
- Aisha T Langford
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; Clinical and Translational Science Institute, New York University Grossman School of Medicine, New York, NY, USA.
| | - Laura D Scherer
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA; Colorado Program for Patient Centered Decisions at ACCORDS, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter A Ubel
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Margaret Holmes-Rovner
- Center for Ethics and Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Karen A Scherr
- Fuqua School of Business, Duke University, Durham, NC, USA; Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA
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20
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Dickey SL, Matthews C, Millender E. An Exploration of Precancer and Post-Cancer Diagnosis and Health Communication Among African American Prostate Cancer Survivors and Their Families. Am J Mens Health 2020; 14:1557988320927202. [PMID: 32452292 PMCID: PMC7252380 DOI: 10.1177/1557988320927202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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21
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Kushalnagar P, Hill C, Carrizales S, Sadler GR. Prostate-Specimen Antigen (PSA) Screening and Shared Decision Making Among Deaf and Hearing Male Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:28-35. [PMID: 30353474 PMCID: PMC6478572 DOI: 10.1007/s13187-018-1436-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Some deaf men who use American Sign Language (ASL) experience barriers in patient-physician communication which may leave them at disparity for shared decision making compared to hearing men. Transparent communication accessibility is needed between deaf male ASL users and their physicians to maximize the benefit to risk ratio of using the prostate-specific antigen (PSA) as a screening tool for early detection. The objective is to compare shared decision-making outcomes between deaf and hearing males who are (1) age-eligible for PSA screening and (2) younger than 45 years old with a family history of cancer. An accessible health survey including questions about PSA test, PCC, modes of communication, and cancer history was administered in ASL to a nationwide sample of deaf adults from February 2017 to April 2018. Two subsamples were created: (1) 45- to 69-year-old men who were age-eligible for PSA testing and (2) 18- to 44-year-old men with a family history of cancer. Age-eligible and younger deaf men with a family history of cancer are at disparity for shared decision making compared to their hearing peers. Regardless of age and PSA testing status, deaf men felt significantly less engaged in shared decision making with their health care providers compared to hearing men. Participation in shared decision making requires not only accessible communication but also cultural competency in working with deaf patients. This is critical in the shared decision-making era in maximizing the benefit of prostate cancer screening in deaf male patient population.
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Affiliation(s)
- Poorna Kushalnagar
- Department of Psychology, Gallaudet University, Washington, D.C., USA.
- Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, D.C., USA.
| | - Colin Hill
- Department of Radiation Oncology, John Hopkins Medicine, Baltimore, MD, USA
| | - Shane Carrizales
- Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, D.C., USA
| | - Georgia R Sadler
- Department of Surgery, University of California at San Diego, San Diego, CA, USA
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22
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Woods-Burnham L, Stiel L, Martinez SR, Sanchez-Hernandez ES, Ruckle HC, Almaguel FG, Stern MC, Roberts LR, Williams DR, Montgomery S, Casiano CA. Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men. CANCER HEALTH DISPARITIES 2020; 4:https://companyofscientists.com/index.php/chd/article/view/169/188. [PMID: 35252767 PMCID: PMC8896511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Recent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality that disproportionately affect African American (AA) men have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in AA men and other men of African ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling. This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates both AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR-together with specific genetic drivers-may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities. Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators should assess racial differences in therapy response and clinical outcomes in order to improve PCa health disparities that continue to exist for AA men.
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Affiliation(s)
- Leanne Woods-Burnham
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Laura Stiel
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
| | - Shannalee R. Martinez
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Evelyn S. Sanchez-Hernandez
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Herbert C. Ruckle
- Department of Surgical Urology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Frankis G. Almaguel
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Loma Linda University Cancer Center, Loma Linda, CA, USA
| | - Mariana C. Stern
- Departments of Preventive Medicine and Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Lisa R. Roberts
- Loma Linda University School of Nursing, Loma Linda, CA, USA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard University School of Public Health
| | - Susanne Montgomery
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
| | - Carlos A. Casiano
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
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23
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Owens OL, Kim S, Tavakoli AS. Are decision aids leading to shared prostate cancer screening decisions among African-American men?: iDecide. Cancer Causes Control 2019; 30:713-719. [PMID: 31093861 DOI: 10.1007/s10552-019-01179-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/09/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE African-Americans have prostate cancer mortality rates that are double their White counterparts. To reduce prostate cancer disparities, it is suggested that men engage in shared decision making about prostate cancer screening with their healthcare provider after learning about the benefits and harms of these screenings. While researchers have developed decision aids to support African-American's screening decisions, there is some uncertainty whether these aids lead to shared decision making. The goal of the current study was to investigate the efficacy of iDecide, a computerized decision aid, for promoting African-American men's engagement in shared decision making. METHODS Six months after their use of iDecide, a prostate cancer screening decision aid, 76 participants were surveyed to determine whether they spoke with a provider about screening, what this conversation entailed, and if shared decision making occurred. RESULTS While iDecide is an effective tool for enhancing African-American's intention to engage in shared decision making, there is no evidence this aid increased their likelihood of discussing prostate cancer with a provider or participation in shared decision making. CONCLUSION Future research should employ stronger research designs and assess the various contexts that can affect the relationship between decision-aid use and shared decision making among African-Americans.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, 1514 Pendleton Street, Columbia, SC, USA.
| | - Simon Kim
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Yale University Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Abbas S Tavakoli
- College of Nursing, University of South Carolina, Columbia, SC, USA
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24
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Watson KS, Henderson V, Murray M, Murphy AB, Levi JB, McDowell T, Holloway-Beth A, Gogana P, Dixon MA, Moore L, Hall I, Kimbrough A, Molina Y, Winn RA. Engaging African American Men as Citizen Scientists to Validate a Prostate Cancer Biomarker: Work-in-Progress. Prog Community Health Partnersh 2019; 13:103-112. [PMID: 31378740 PMCID: PMC6693518 DOI: 10.1353/cpr.2019.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND African American men (AAM) are under-represented in prostate cancer (PCa) research despite known disparities. Screening with prostate-specific antigen (PSA) has low specificity for high-grade PCa leading to PCa over diagnosis. The Prostate Health Index (PHI) has higher specificity for lethal PCa but needs validation in AAM. Engaging AAM as citizen scientists (CSs) may improve participation of AAM in PCa research.Results and Lessons Learned: Eight CSs completed all training modules and 139 AAM were recruited. Challenges included equity in research leadership among multiple principal investigators (PIs) and coordinating CSs trainings. CONCLUSIONS Engaging AAM CSs can support engaging/recruiting AAM in PCa biomarker validation research. Equity among multiple stakeholders can be challenging, but proves beneficial in engaging AAM in research. OBJECTIVES Assess feasibility of mobilizing CSs to recruit AAM as controls for PHI PCa validation biomarker study. METHODS We highlight social networks/assets of stakeholders, CSs curriculum development/implementation, and recruitment of healthy controls for PHI validation.
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Affiliation(s)
- Karriem S. Watson
- University of Illinois Cancer Center at University of Illinois at Chicago
- University of Illinois at Chicago School of Public Health, Division of Community Health Sciences
| | - Vida Henderson
- University of Illinois Cancer Center at University of Illinois at Chicago
- University of Illinois at Chicago School of Public Health, Division of Community Health Sciences
| | | | - Adam B. Murphy
- Robert H. Lurie Cancer Comprehensive Cancer Center at Northwestern University
- Department of Urology, Northwestern Medicine, Feinberg School of Medicine
| | - Josef Ben Levi
- College of Arts and Sciences, Northeastern Illinois University
| | | | - Alfreda Holloway-Beth
- Project Brotherhood
- Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health
- Cook County Department of Public Health
| | - Pooja Gogana
- Department of Urology, Northwestern Medicine, Feinberg School of Medicine
| | - Michael A. Dixon
- Department of Urology, Northwestern Medicine, Feinberg School of Medicine
| | - LeAndre Moore
- Chicago Global Health Alliance
- School of Public Health, University of Illinois at Chicago
| | - Ivanhoe Hall
- University of Illinois Cancer Center at University of Illinois at Chicago
| | - Alexander Kimbrough
- School of Public Health, Division and Epidemiology and Biostatistics, University of Illinois at Chicago
| | - Yamilé Molina
- University of Illinois Cancer Center at University of Illinois at Chicago
- University of Illinois at Chicago School of Public Health, Division of Community Health Sciences
| | - Robert A. Winn
- University of Illinois Cancer Center at University of Illinois at Chicago
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25
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Scalia P, Elwyn G, Kremer J, Faber M, Durand MA. Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid. JMIR Cancer 2018; 4:e11102. [PMID: 30463840 PMCID: PMC6282011 DOI: 10.2196/11102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023] Open
Abstract
Background Randomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. Objective The objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes. Methods Data were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference. Results Of all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift. Conclusions Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Jan Kremer
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, Netherlands
| | - Marjan Faber
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, Netherlands
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
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