Department of Hematology and Medical Oncology, Geisinger Cancer Institute, Geisinger Medical Center, Danville, PA, USA.
Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.
Cancer Invest. 2021 Feb;39(2):124-132. doi: 10.1080/07357907.2020.1855441. Epub 2021 Jan 7.
Prostate cancer incidence and mortality in the United States in African Americans (AA) are higher than in Caucasians. Eastern Cuyahoga County in Ohio is majority AA and is considered an underserved population particularly vulnerable to healthcare disparities. There is a paucity of data about shared decision making among high-risk AA men with regard to prostate cancer screening. This study aims to examine shared versus informed decision making (SDM versus IDM) in a randomized, control trial among a large, high-risk AA population.
Patients were included in annual one-day outreach events, each held over 3 years (2017-2019), and were randomized at each event into IDM (control) and SDM (investigational) groups and then were offered screening via prostate specific antigen (PSA) and digital rectal exam (DRE). The primary endpoints were proportion of participants over 40 who did not demonstrate decisional conflict about prostate cancer screening measured by the SURE score, as well as change of knowledge score about prostate cancer screening.
Overall, 175 patients were enrolled in the trial; 79 in the SDM arm and 96 in the IDM arm. The investigational (SDM) arm had 3/79 (3.9%) conflict versus 6/96 (6.4%) in the control (IDM) arm ( = 0.74). With regard to knowledge improvement, the SDM cohort demonstrated improvement following educational tools for 66/79 (81%) of participants versus 76/96 (79%) in the IDM cohort ( = 0.85). There was no difference in the proportion (63%) of participants in either group who found the information very helpful (using a Likert scale).
Our education-based study showed no significant difference between SDM and IDM with regard to decisional conflict about prostate cancer screening. The study also demonstrated significant improvement in knowledge about prostate cancer screening in a high-risk AA population in both groups. Our results should be interpreted with caution due to several limitations; however, the study can serve as a benchmark for future studies in this very important topic.
美国非裔美国人（AA）的前列腺癌发病率和死亡率高于白种人。俄亥俄州东凯霍加县主要是 AA 人口，被认为是服务不足的人群，特别容易受到医疗保健差异的影响。关于高风险 AA 男性在前列腺癌筛查方面的共享决策，数据很少。本研究旨在一项大型高危 AA 人群的随机对照试验中，研究共享决策（SDM）与知情决策（IDM）。
患者参加每年为期一天的外展活动，每次活动持续 3 年（2017-2019 年），在每次活动中随机分为 IDM（对照组）和 SDM（实验组）组，并通过前列腺特异性抗原（PSA）和直肠指检（DRE）进行筛查。主要终点是 40 岁以上参与者中通过 SURE 评分测量的前列腺癌筛查决策无冲突的比例，以及前列腺癌筛查知识评分的变化。
共有 175 名患者参加了试验；SDM 组 79 例，IDM 组 96 例。实验组（SDM）有 3/79（3.9%）有冲突，对照组（IDM）有 6/96（6.4%）（=0.74）。关于知识的提高，SDM 队列在使用教育工具后，79 名参与者中的 66/79（81%）有改善，而 IDM 队列中的 76/96（79%）有改善（=0.85）。在两组中，有 63%的参与者认为信息非常有帮助（使用李克特量表）。
我们的基于教育的研究表明，在前列腺癌筛查的决策冲突方面，SDM 与 IDM 之间没有显著差异。该研究还表明，在高危 AA 人群中，两组的前列腺癌筛查知识都有显著提高。由于存在一些限制，我们的结果应谨慎解释；然而，该研究可以作为这一非常重要主题的未来研究的基准。
