Choosing Channels, Sources, and Content for Communicating Prostate Cancer Information to Black Men: A Systematic Review of the Literature

Shop Talk: A Qualitative Study to Understand Peer Health-related Communication Among Black Men at the Barbershop

BACKGROUND

While successful health promotion efforts among Black men have been implemented at barbershops, the focus has largely been on outcomes as opposed to the processes by which outcomes are produced. An understanding of processes can be leveraged in the design and implementation of future efforts to improve the health of Black men.

PURPOSE

The objectives of the present study were to: (i) understand peer-derived sources of health-related support at the barbershop and (ii) understand the role of the barbershop in promoting health among Black men.

METHODS

Seven focus groups were conducted at barbershops used predominately by Black men. Each focus group lasted between 45 and 60 min. Using a thematic approach, each focus group was independently coded by two coders using a codebook derived from an inductive and deductive approach. The results were confirmed with members of the community advisory board.

RESULTS

Three themes emerged: (i) dynamic and candid exchange of health-related support at the barbershop; (ii) tailored forms of health-related and judgment-free communication that provide encouragement and increase motivation; and (iii) characteristics of a supportive environment at the barbershop that facilitate health-related communication.

CONCLUSIONS

The findings of the present study offer a potential pathway for public health efforts seeking to improve health among Black men. Those interested in designing and implementing these efforts can create tailored programs for Black men by recognizing and leveraging the unique dynamics of health-related conversations at the barbershop.

Prostate Cancer Foundation Screening Guidelines for Black Men in the United States

BACKGROUND

In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States.

METHODS

A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.

CONCLUSIONS

These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).

Disparities Associated with Shared Decision-making in Prostate Cancer Screening

BACKGROUND

Prostate cancer screening guidelines recommend shared decision-making (SDM) regarding prostate-specific antigen (PSA) testing. However, it is unclear who undergoes SDM and whether any disparities exist.

OBJECTIVE

To examine sociodemographic differences in participation of SDM and its association with PSA testing in prostate cancer screening.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cross-sectional study was conducted among men aged 45-75 yr undergoing PSA screening, using the 2018 National Health Interview Survey database. The evaluated sociodemographic features included age, race, marital status, sexual orientation, smoking status, working status, financial difficulty, US geographic regions, and cancer history. Questions regarding self-reported PSA testing and whether respondents discussed its advantages and disadvantages with their healthcare provider were analyzed.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Our primary outcome was to evaluate the possible associations between various sociodemographic factors and undergoing PSA screening and SDM. We used multivariable logistic regression analyses to detect potential associations.

RESULTS AND LIMITATIONS

A total of 59596 men were identified, of whom 5605 answered the question regarding PSA testing, with 2288 (40.6%) undergoing PSA testing. Of these men, 39.5% (n = 2226) discussed the advantages and 25.6% (n = 1434) discussed the disadvantages of PSA testing. On a multivariable analysis, older (odds ratio [OR] 1.092; 95% confidence interval [CI] 1.081-1.103, p < 0.001) and married (OR 1.488; 95% CI 1.287-1.720, p < 0.001) men were more likely to undergo PSA testing. Although Black men were more likely to discuss PSA advantages (OR 1.421; 95% CI 1.150-1.756, p = 0.001) and disadvantages (OR 1.554; 95% CI 1.240-1.947, p < 0.001) than White men, this did not correlate with higher rates of PSA screening (OR 1.086; 95% CI 0.865-1.364, p = 0.477). The lack of important clinical data remains a limitation.

CONCLUSIONS

Overall, SDM rates were low. Older and married men had an increased likelihood of SDM and PSA testing. Despite higher rates of SDM, Black men had similar rates of PSA testing to White men.

PATIENT SUMMARY

We evaluated sociodemographic differences in shared decision-making (SDM) in prostate cancer screening using a large national database. We found that SDM had varying results in different sociodemographic groups.

An Exploration of Black Men's Attitudes and Experiences Communicating with Dentists about Oral and Pharyngeal Cancer

BACKGROUND

Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists' limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the attitudes and experiences that Black men have communicating with dentists about OPCs.

METHODS

To qualitatively assess these attitudes and experiences, a focus group guide and recruitment strategy were developed using a community engagement approach. Data were analyzed using grounded theory.

RESULTS

Twenty-three self-identified Black men participated in three focus groups through the Zoom platform (mean age of 46.1 years). Four main themes emerged, which identified that participants: (1) had little knowledge of OPCs; (2) felt that addressing OPC risk among Black men was not a priority for dentists; (3) stressed the importance of dentists acknowledging the complexity of how race and gender affects Black men's healthcare experiences; and (4) expressed a benefit to receiving information from multiple social networks.

CONCLUSION

The focus groups provided context for how dentists might engage with Black men in discussions about OPC prevention and treatment.

Self-efficacy to Get Cancer-Related Information or Advice

Self-efficacy, or confidence, for being able to get cancer information may affect a person's understanding of cancer risk and subsequent cancer-related decisions such as screening, treatment, and genetic testing. In this study, we explored key correlates associated with self-efficacy for getting cancer information. We analyzed cross-sectional data from the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2). There were 3504 responses in the full dataset; 2513 remained after eliminating respondents with incomplete data for all variables of interest. Self-efficacy for getting cancer information was assessed with the item, "Overall, how confident are you that you could get advice or information about cancer if you needed it?" First, we explored correlates associated with self-efficacy in getting cancer information including sociodemographic factors, patient-provider communication, and health-related self-efficacy in the full sample. Secondarily, we examined associations between self-efficacy to get cancer information and cancer information-seeking burden (e.g., difficulty understanding cancer information) in the subset of participants who reported ever looking for cancer-specific information. Descriptive statistics and logistic regressions were conducted. Asian race/ethnicity, higher perceived quality of patient-provider communication, and higher health-related self-efficacy were associated with higher odds of confidence about getting cancer information. In the subset of people who ever sought cancer-specific information, higher patient-provider communication scores, higher health-related self-efficacy, greater difficulty understanding information, greater concern about the quality of information, and greater frustration during the search were associated with higher self-efficacy for getting cancer information. Future research should evaluate strategies to improve cancer information seeking skills.

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.

Effectiveness of a Community Health Worker-Led Intervention on Knowledge, Perception, and Prostate Cancer Screening among Men in Rural Kenya

Background

Globally, an increase in mortality from prostate cancer (PC) remains a big challenge with disparities existing with a slight preponderance among men in low and middle-income countries. Prostate cancer is a leading cause of mortality among men in sub-Saharan Africa. In Kenya, despite the majority of men presenting with advanced prostate cancer for treatment, knowledge and screening for prostate cancer is low. The study aimed to examine the effectiveness of a community health worker-led education intervention on knowledge, perception, and PC screening.

Methods

This was a quasiexperimental study among Kenyan men aged 40–69 years. The intervention site was Gatundu North subcounty and the control site was Kiambu subcounty in Kiambu County. Stratified random sampling was applied to select 288 respondents per arm of the study. We used a pretested interviewer-administered questionnaire to collect data at baseline and 6 months postintervention. Pearson's chi-square test was used for data analysis.

Results

Awareness of prostate cancer significantly increased postintervention (P < 0.05). The proportion of respondents who had good knowledge of prostate cancer increased significantly from 49% to 76.4%(P < 0.05) in the intervention arm. The proportion of respondents with a high perception of self-vulnerability increased significantly from 26% to 42.1% (P < 0.05). The proportion of men who had undergone PC screening significantly increased from 4.5% to 20.4% (P < 0.05) in the intervention arm. In postintervention, there was a statistically significant difference in the proportion of men screened for prostate cancer in the intervention and control arm (P < 0.05).

Conclusion

Health education by community health workers during household visits increased awareness and knowledge, perception, and uptake of PC screening. Utilization of community health worker delivered education is an effective strategy that requires to be adopted to enhance screening.

Encouragement of cervical cancer screening via an evolutionary theoretical approach: a randomized controlled study in Japan

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This is the first study of evolutionary approaches to encourage cancer screening.

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We tested the effect of a message targeting the fundamental human motive of kin care.

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Kin care messages are such as “get cervical cancer screening for future childbirth.”

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A message targeting the fundamental motive of disease avoidance was also tested.

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The kin care message was as effective as the disease avoidance message.

The introduction of an evolutionary perspective into public health research has received attention in recent years. We aimed to examine the effects of messages that target the fundamental human motive of kin care (i.e., childbirth and parenting) on cervical cancer screening recommendations, based on an evolutionary theoretical approach. A randomized controlled study was conducted in Japan. Female participants (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care (recommending cervical cancer screening for future childbearing), or that targeted the fundamental motive of disease avoidance, or a control message. Intention to obtain cervical cancer screening was assessed both before and after reading the messages. A one-way ANOVA with Tukey’s or Games–Howell test was conducted. Each of the intervention message targeting the fundamental motive of kin care and of the message targeting disease avoidance significantly increased intention to obtain cervical cancer screening versus a control message (M = 0.76 vs. M = 0.17, p < 0.001; M = 0.74 vs. M = 0.17, p < 0.001, respectively). A message that targeted the fundamental motive of kin care was as effective as one targeting the fundamental motive of disease avoidance. Health professionals should add messages that target the fundamental motive of kin care to their repertoire to encourage cervical cancer screening among women who wish future childbirth and parenting (e.g., “Delayed detection of cervical cancer may prevent your future childbirth and parenting. So let’s obtain cervical cancer screening regularly for your future childbirth and parenting.”)

Development of a Minority Prostate Cancer Research Digest: Communication Strategy Statement for Black Men

Since prostate cancer incidence, prevalence and mortality are still highest among Black men in the United States, it is important to effectively address the factors that contribute to prostate cancer disparities in this at-risk population as well as their low participation in biomedical research/clinical trials. An effective communication strategy that can be used to disseminate information with high public health impact to Black men is one way to combat prostate cancer disparities. The objective of this study was to develop a Minority Prostate Cancer (MiCaP) research communication strategy using focus group methodology and expert in-depth interviews. The communication strategy statement developed in this study provides a guide for message concepts and materials for Black men, including communication content, source, channel, and location. Specifically, it provides recommendations on how to deliver information, how to choose the language and relevant images, how to gain attention, who is preferred to deliver messages, and other ways to engage Black men in health communication strategies. The communication strategy statement was used to develop the MiCaP Research Digest, a research communication program that is currently being tested in Orange County, Duval County, Leon County, Gadsden County, and the Tampa Bay area of Florida.

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient-oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust.

Predictors of annual prostate-specific antigen (PSA) screening among black men: results from an urban community-based prostate cancer screening program

BACKGROUND AND OBJECTIVE

Black men have an increased risk of prostate cancer mortality compared with any racial or ethnic group. Further, research on prostate cancer prevention and control messaging focusing on Black men is limited. Community screening events are successful in attracting members from high-risk groups, like Black men, and are a valuable source to collect cancer screening and health promotion data. Therefore, the authors examined data of Black men attending a community-based PCa screening event to evaluate predictors of annual PCa screening, and identify sub-populations of Black men needing targeted cancer prevention messaging.

METHODS

Black men attending PCa screening events in St. Louis, MO 2007-2017 were eligible. Participants completed either a mail-in or on-site survey at the time of their screening to collect information on annual screening history. We analyzed sociodemographic factors, having a first-degree relative with a history of PCa, healthcare utilization characteristics, and predictors of annual PSA screening. Logistic regression analysis was used to assess the association between predictors and annual PSA screening.

RESULTS

Data was analyzed from 447 respondents. One-third of the residents did not know their cancer family history status. Older age and having a primary healthcare provider predicted an annual prostate cancer after attending the PCa community screening event. In the fully adjusted model, all ages older than 45 years were 2-4 times more likely to have an annual PCa screening. Having a healthcare provider also predicted an annual PCa screening (OR: 4.59, 95% CI: 2.30-9.14).

CONCLUSION

Regardless of sociodemographic and family history factors, older Black men and those with a primary physician are more likely to have an annual PSA screening. Cancer prevention promotion efforts for Black men should target mechanisms that facilitate family cancer history conversations to engage younger Black men. Also, additional health promotions efforts are needed to educate Black men without a primary healthcare provider.

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. Although commonly discussed in the context of men of African descent, disparities also exist based on socioeconomic level, education level, and geographic location. The factors in these disparities span systemic access issues affecting availability of care, provider awareness, and personal patient views and mistrust. In this review, we will discuss common themes that patients have noted as impediments to care. We will review how equitable access to care has helped improve outcomes among many different groups of patients, including those with local disease and those with metastatic castration-resistant prostate cancer. Even with more advanced presentation, challenges with recommended screening, and lower rates of genomic testing and trial inclusion, Black populations have benefited greatly from various modalities of therapy, achieving comparable and at times superior outcomes with certain types of immunotherapy, chemotherapy, androgen receptor-based inhibitors, and radiopharmaceuticals in advanced disease. We will also briefly discuss access to genomic testing and differences in patterns of gene expression among Black patients and other groups that are traditionally underrepresented in trials and genomic cohort studies. We propose several strategies on behalf of providers and institutions to help promote more equitable care access environments and continued decreases in prostate cancer disparities across many subgroups.

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exist among Black men in this country. The primary objective of this systematic review is to describe the reported disparities in screening, diagnostics, and treatments as well as efforts to alleviate these disparities through community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, subanalyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal-access care environments have shown similar outcomes regardless of race. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials, and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. IMPLICATIONS FOR PRACTICE: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher prostate-specific antigen, and other adverse factors, but outcomes can be attenuated in trials or in equal-access care environments. Recent data have shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts, and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities.