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Purpose: There is no consensus regarding the risks and benefits of screening for early-stage prostate cancer. Medical organizations encourage shared decision making both to improve understanding and reach individualized decisions. The question then becomes, what is necessary for an “individualized” decision? An additional complexity is that low-income, African-American (A-A) men are even less likely to be screened and at greater risk of being diagnosed with advanced stages of disease. The aim of this research was two-fold: (1) identify issues and values associated with this decision from two sources, A-A patients at-risk for prostate cancer and A-A patients’ wives, and (2) examine specific cognitive processes that may differentially impact the screening decision.
Methods: A triangulation methodology was used involving two qualitative methods: 4 focus groups each with 6-8 low-income, A-A male patients over 40 with no history of prostate cancer, and 4 focus groups with 4-7 wives, followed by semi-structured interviews. The focus groups were used to map the domain of relevant issues. The follow-up interviews confirmed and validated the findings with participants from the original focus groups and a new set of participants.
Results: Preliminary results identified the importance of both cognitive and affective factors. Cognitive themes included an anticipated shift with aging in the trade-off between quality and quantity of life (as one gets older, the quality of one’s sex life may be less important than living long enough to play other social roles, such as grandfather), and anticipated diminishing marginal loss (recognizing that the incremental loss of sexual functioning at an older age may be less painful). Emotional themes included both regret and uncertainty avoidance, especially pronounced for wives as vicarious decision makers; unexpected benefits of learning one has cancer (from the viewpoint of strengthening relationships and valuing every day of life); the unique contributions of family members to the decision; and the significant role of spirituality, prayer, and fatalism.
Conclusions: Preliminary findings demonstrate the complexity of this choice for A-A men and women. Theoretically, this work allows us to understand better the cognitive and emotional processes underlying this decision. From an applied standpoint, this work points us towards unexplored avenues to improve management decisions for early-stage prostate cancer detection for A-A men at greater risk for the disease.
See more of Oral Concurrent Session B - Screening in Chronic Disease
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)