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Promoting informed prostate cancer screening decision-making for African American men in a community-based setting



Current screening guidelines for prostate cancer (PCa) encourage men to make individual screening decisions after consulting with their primary care provider to weigh the risks and benefits of undergoing prostate specific antigen (PSA) testing, but many men at high risk of PCa diagnosis (notably African American men) are more likely to be uninsured and lack a primary care provider. An academic-community partnership redesigned its community-based screening program to ensure access to services for African American men, incorporating a session with a trained clinical educator in community settings, designed to increase knowledge and promote informed decision-making regarding PSA testing. This study evaluated effects of the intervention on decision-making outcomes.


To evaluate program efficacy, 88 men completed pre- and post-test surveys assessing outcomes of interest.


Participants’ knowledge, beliefs, attitudes, anxiety levels, and self-efficacy all improved from pre- to post-test at a statistically significant level. Most notably participants’ awareness that PCa is often not life-threatening, and watchful waiting is a reasonable treatment option increased after the encounter. More than half of the study sample felt they had received enough knowledge to make an informed decision about whether the PSA test was right for them.


Our findings show the program had positive effects on men’s ability to make informed decisions about PCa screening and demonstrate that educational outreach programs with an emphasis on informed decision-making can effectively balance screening guidelines with the needs of underserved populations in community settings to improve outcomes.

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Data availability

The data that support the findings of this study are available on request from the corresponding author SN. The data are not publicly available due to restrictions that protect research participant privacy.

Code availability

Not applicable.


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The study was funded by Emerson, Ascension Health, and Express Scripts.

Author information

Authors and Affiliations



Intervention and study conception and design were performed by RJW, SN, PA, KJ, MS, RWJ and SS. Material preparation and data collection were performed by SN, PA and KJ; data analysis was performed by RJW, SN, ME, KJ, AKT, and NH. The first draft of the manuscript was written by RJW; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Shannon E. Nicks.

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Conflict of interest

None of the authors report a conflict of interest for this study.

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Appendix 1 Pre-test and Post-test survey scales and items

Appendix 1 Pre-test and Post-test survey scales and items

Knowledge items



Not sure/I don’t know

The chance of getting prostate cancer increases with age


The prostate specific antigen (PSA) test will detect prostate cancers


A prostate biopsy can tell you with more certainty whether you have prostate cancer than a prostate specific antigen (PSA) test can


Prostate cancer is more common in Caucasian (White) men than African American men


Most men will die of something other than prostate cancer


Men who have an abnormal screening result may be advised to have a biopsy as follow-up


Men who are treated for early prostate cancer are at risk for having sexual or urinary function problems


Watchful waiting and active surveillance are options for men diagnosed with prostate cancer


Screening-related attitudes and beliefs

Strongly disagree


Neither agree nor disagree


Strongly agree

It is important for a man to think about what he would do if he has an abnormal test result, before getting tested for prostate cancer


It is important for a man to weigh the potential pros and cons of getting tested for prostate cancer before deciding whether or not to be tested


If a man chooses not to be tested for prostate cancer, that is okay


I think the chance that I will develop prostate cancer is high


Having prostate cancer screening makes sense for me


Prostate cancer and screening-related anxiety

Not at all




Any reference to prostate cancer brought up strong feelings in me


Even though it’s a good idea, I found that getting a PSA test scared me


Whenever I heard about a friend or public figure with prostate cancer, I got more anxious about my having prostate cancer


When I thought about having a PSA test, I got more anxious about my having prostate cancer


Other things kept making me think about prostate cancer


I felt kind of numb when I thought about prostate cancer


I thought about prostate cancer even though I didn’t mean to


I had a lot of feelings about prostate cancer, but I didn’t want to deal with them


I had more trouble falling asleep because I couldn’t get thoughts of prostate cancer out of my mind


Just hearing the words “prostate cancer” scared me


Screening decision self-efficacy

Strongly disagree


Neither agree or disagree


Strongly agree

I have enough information about prostate cancer


My decision whether to get screened for prostate cancer is based on complete information


I have made up my own mind about whether to get screened for prostate cancer


I am confident that I can make an informed decision about getting screened for prostate cancer


Intention to engage with provider

Strongly disagree


Neither agree or disagree


Strongly agree

I plan to talk to my health care provider about prostate cancer


I plan to talk to my health care provider about getting screened for prostate cancer


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Wray, R.J., Nicks, S.E., Adsul, P. et al. Promoting informed prostate cancer screening decision-making for African American men in a community-based setting. Cancer Causes Control 33, 503–514 (2022).

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  • Prostate cancer
  • Health disparities
  • Cancer screening
  • Decision-making
  • Community-based participatory research