BERKELEY, CA (UroToday.com) - African American (AA) men suffer disproportionally from prostate cancer (Pca) in terms of incidence and mortality rates. Pca is the fourth most common reason overall for death in AA men; nearly one in five will be diagnosed with Pca, and 5% of those will die from the disease. Because AA men generally present with Pca at a more advanced stage than Caucasians, this disparity may be due, in part, to the fact that AA men receive less prostate specific antigen (PSA) testing.
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However, bridging the disparity gap is complicated by the fact that there is currently significant controversy about the utility of PSA testing as a tool for Pca screening. The US Preventive Services Task Force recommends against routine Pca screening for all population groups, including AAs. Other professional groups, including the American Cancer Society, the American Urologic Association, and the National Comprehensive Cancer Network, recommend periodic screening and/or individualized screening decisions for selected categories of men at elevated risk, including AA men. In view of this divergence, most organizations emphasize the need for personalized, informed decision making with a physician.[3, 4, 5] Although educational aids have been developed for AA men that encourage them to engage in informed decision making with a provider (e.g., the Centers for Disease Control brochure for AA men, these tools may not adequately address men’s barriers to initiating a conversation with their providers.
Female partners have been shown to serve as powerful motivators for their mates to encourage provider discussions and provide incentives and strategies for enacting plans to schedule discussions in a variety of other contexts. Therefore, the provision of prostate cancer risk information, targeted to the female partner, may help to motivate their mates to take steps needed to schedule a physician appointment to discuss and evaluate their personal screening options.
In this article, we report findings of a randomized trial that examined the impact of a print brochure designed to support female partners of AA men in motivating and assisting their mates to schedule a meeting with their healthcare provider to discuss their screening options. To explore the impact of the spouse, partners received either the CDC brochure alone, or in combination with the “partner” brochure.
The study was guided by the Cognitive-Social Health Information Processing model (C-SHIP), which delineates the cognitive and affective factors involved in processing and acting on health information (e.g., knowledge, perceived risk, self-efficacy, and strategies for managing distress). Further, the C-SHIP delineates two prototypic styles for coping with health threats: “high monitoring” (in which individuals attend to and scan for threatening health cues), and “low monitoring” (in which individuals distract from and minimize threat-relevant cues). High monitoring is associated with a distinctive pattern of reactions to a range of medical stressors and risk communications, including higher knowledge and perceived risk regarding health threats, more negative expectations about the severity and consequences of a health threat if left unattended, and higher levels of cancer-related distress when faced with threatening medical feedback.
There is also accumulating evidence that the monitoring style of individuals influences decision making not only with respect to their own health threats, but also with respect to the health threats of their family members. For example, being a high monitor is associated with a greater likelihood of discussing cancer-related topics with diagnosed patients in one’s family. The female partners of AA men thus appear to represent an important, but untapped, resource for facilitating a conversation between their mates and their health care providers about screening decisions.
Consistent with our conceptualization, the study results highlight three main conclusions. First, the female partners’ monitoring style moderated the impact of the partner brochure. That is, mates were more likely to think about initiating a provider visit when the partner was a high monitor who received the intervention brochure. Second, independent of whether the partner received the partner brochure, the mates of high monitors were more likely to take active steps to initiate a provider visit to discuss Pca screening. Third, the older the partner, and the more educated, the more likely her mate was to initiate a provider visit.
These findings indicate that female partners may be an important route to engaging AA men in informed decision making with a provider in the context of Pca screening decisions. Further, the impact of psycho-educational interventions may be enhanced by tailoring messages to the partner’s monitoring style by providing high monitors with more detailed information and strategies to incentivize their mates. Future steps in research include the development and evaluation of effective protocols for reaching out to partners so that they can participate more systematically in prostate cancer screening behaviors. The use of m-health interventions may provide one useful channel for this outreach.
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- Hosain GM, Sanderson M, Du XL, Chan W, Strom SS. Racial/ethnic differences in predictors of PSA screening in a tri-ethnic population. Cent Eur J Public Health 2011 Mar19; 30-34.
- Wolf A, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA-Cancer J. Clin. 2010; 60 (2):70–98.
- Carter, HB, Albertsen, PC, Barry MJ, et al. Early detection of prostate cancer: American Urological Association (AUA) guideline, 2013.
- Carroll, PR, Parson, JK, Andriole, G, et al. Prostate cancer early detection, version 1.2014. J Nat Compr Canc Netw, 2014 Sept; 12(9) 1211-1219.
- Prostate cancer screening: a decision guide for African Americans. CDC; 2003.
- Miller SM, Bowen DJ, Croyle RT, Rowland JH. (Eds.) Handbook of Cancer Control and Behavioral Science: a resource for researchers, practitioners, and policymakers. American Psychological Association; 2008, Washington DC (Foreward by Dr. David Abrams)
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- Roussi, P. & Miller, S.M. (2014) Monitoring style of coping with cancer related threats: A review of the literature. J Beh Med, Oct; 37(5): 931-54.
- Mellon S, Janisse J, Gold R, et al. Predictors of decision making in families at risk for inherited breast/ovarian cancer. Health Psychol 2009 Jan; 28 (1):38:47.
Suzanne M. Miller, PhD, Professor and John Scarpato, MA, Project Managerb as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Psychosocial and Behavioral Medicine, Fox Chase Cancer Center/Temple Health, Philadelphia, PA, USA
This work was supported in part by DOD grantW81XWH-06-1-0099, as well as ACS grant PBP 89318, DOD grant DAMD 17-01-1-0006, NCI grant R01 CA158019, and P30 CA06927. We thank Dr. Pagona Roussi and Mary Anne Ryan for their technical assistance.