Project Summary:
Prostate cancer (PC) is the most frequently diagnosed cancer among men in Wisconsin and the second leading cause of cancer death. When detected early, survival rates approach 100%. However, large Black-White disparities exist. Multiple factors are at cause, but low screening uptake is a contributor. The U.S. Preventative Services Task Force (USPSTF) changed PC screening guidelines, causing confusion among patients and providers. Following the change, prostate-specific antigen (PSA) testing decreased 3-10% across regions, with evidence suggesting a greater reduction among Black men.
To support patient-provider discussions of PC risk and guideline concordant care, the USPSTF recommends shared decision making (SDM). SDM is a collaborative process in which healthcare providers and patients work together to make informed choices that align with patient values and preferences. Despite its promise, SDM is underutilized in Black men, due to multiple barriers including provider knowledge of PC risk and guidelines, a lack of tools to facilitate the discussion, and insufficient knowledge and experience with SDM among providers and patients.
To address persistent disparities in PC screening and outcomes among Black men, this study will develop and evaluate a multi-level intervention targeting healthcare providers and Black men at risk for PC. A Human-centered design (HCD) approach will ensure the intervention is responsive to need and context. Implementation and evaluation will be guided by the Practical, Robust Implementation and Sustainability Model (PRISM), which systematically assesses multi-level factors influencing adoption, sustainability, and equitable impact.
The proposed aims will advance the field by examining 1) the implementation and impact of provider education on provider knowledge of PC risk and screening guidelines for Black men and use of SDM; 2) the feasibility of SDM in primary care settings; and 3) the effects of SDM on decisional conflict and PC screening uptake among patients.