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Does Shared Decision-Making for Prostate Cancer Screening Among African American Men Happen? It Depends on Who You Ask

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Shared decision-making (SDM) is recommended for prostate cancer screening, but little is known about how this process is perceived by patients and providers. SDM is especially important for African American men, who are at high risk for the disease.

Objective

To evaluate agreement in SDM ratings among patients, providers, and objective observers.

Method

African American men ages 45–70 were recruited from primary care practices to participate in a study evaluating a decision aid (DA). Immediately after using the DA, patients proceeded to primary care appointments. Afterwards, patients and physicians completed surveys assessing perceptions about SDM. Clinical visits were also audio-recorded and coded to assess SDM.

Results

Mean scores on SDM measures among patients were 73.2 (SD = 27.5, 95% CI 55.71–90.62), 83.1 among physicians (SD = 7.8 95% CI 78.14–88.06), and 67.1 among objective raters (SD = 36.8 95% CI 43.72–90.45). Among patient-provider dyads, mean agreement was 49.9%.

Conclusion

Patients, physicians, and objective observers perceived SDM differently. Understanding discordant experiences of SDM is vital for improving clinical guidance about SDM especially among African Americans who have historically faced healthcare discrimination and mistrust. DAs, particularly for African American men, should incorporate strategies to empower patients to advocate for their communication needs and preferences.

Trial Registration

Clinical trials identifier number: NCT02787434

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Data Availability/Transparency

The dataset generated and analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Abbreviations

PSA:

prostate-specific antigen

DA:

decision aid

SDM:

shared decision-making

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Funding

Financial support for this study was provided in part by a grant from the National Institutes of Minority Health and Disparities (5R21CA178296, PI Allen) and by the David E. Mazzone Foundation (PI Allen). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

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Authors and Affiliations

  1. Department of Community Health, School of Arts and Sciences, Tufts University, 574 Boston Avenue, Medford, MA, 02155, USA

    Jennifer D. Allen, Amy Kaplan & Keren Ladin

  2. Department of Occupational Therapy, Tufts University, 574 Boston Avenue, Medford, MA, 02155, USA

    Thalia Porteny & Keren Ladin

  3. Research Technology, Tufts Technology Services, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA

    Kyle Monahan

  4. Department of Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, WA, 98195, Seattle, USA

    Donna L. Berry

Authors
  1. Jennifer D. Allen
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  4. Keren Ladin
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Contributions

All authors made substantial contributions to the interpretation of data and have drafted the work or substantively revised it. All authors have approved the submitted version. JDA: Conceived of study. Drafted the article. TP: Made substantial contribution to the data analysis, interpretation. Drafted sections of article. AK: Made substantial contribution to the data analysis, interpretation. KL: Critically revised article for important intellectual content. Approved final manuscript. KM: Made substantial contribution to the data analysis, interpretation. Drafted sections of the article. DLB: Made substantial contributions to the study concept and design. Critically revised article for important intellectual content.

Corresponding author

Correspondence to Jennifer D. Allen.

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Ethics

All study procedures were approved by the Institutional Review Boards at Tufts University, Emory University School of Medicine, and the Atlanta VA Medical Center.

Consent for Participation/Publication

Written informed consent for publication of findings was obtained from all participants. We confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) are not identifiable and cannot be identified through the details of the manuscript.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Allen, J.D., Porteny, T., Kaplan, A. et al. Does Shared Decision-Making for Prostate Cancer Screening Among African American Men Happen? It Depends on Who You Ask. J. Racial and Ethnic Health Disparities 9, 1225–1233 (2022). https://doi.org/10.1007/s40615-021-01064-x

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  • DOI: https://doi.org/10.1007/s40615-021-01064-x

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