In a study published in the August 2007 issue of the American Journal of Preventive Medicine, researchers examined the effects of two simple tools on discussions about, and screening tests for, prostate cancer. Medical guidelines currently recommend that men talk with their doctor about whether or not to get tested for prostate cancer. However, strategies for encouraging discussion of prostate cancer in high-risk populations are not well tested.
Dr. Sunil Kripalani, MD, MSc, assistant professor, Emory University School of Medicine, believes the findings from the new study demonstrate "that such patient interventions are effective in underserved populations, and they work primarily by empowering men to raise the topic with their doctor."
With the new study, an inner-city primary care clinic was the setting to look at 250 men ages 45 to 70 with no prior history of prostate cancer. Over 90 percent of the participants were African American and about 79 percent read below ninth grade level.
Prostate cancer is the most common cancer in American men, with an estimated incidence of 234,460 cases and 27,360 deaths in 2006. Screening for prostate cancer remains controversial due to insufficient evidence to recommend for or against screening.
In the study, patients received either a detailed educational handout about prostate cancer screening (PtEd group), a simple handout encouraging them to talk to their doctor (Cue group) or a control handout (control group). None of the interventions advocated for or against screening.
After each patient had seen a physician or nurse practitioner, an interviewer (blinded to which intervention had occurred) asked a series of questions about what was discussed with the caregiver. Participants were also assessed for their health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) test. The interviewer also determined whether a Prostate Specific Antigen (PSA) test was ordered that day, or whether a Digital Rectal Exam (DRE) was done.
While 48 percent of all patients reported discussing prostate cancer, 58 percent of the Cue group and 50 percent of the PtEd group reported discussions, against only 37 percent of the control group. Further, when prostate cancer was discussed, both the Cue group (40 percent) and the PtEd group (48 percent) initiated the conversations, compared to only 10 percent of the control group.
Writing in the article, Dr. Kripalani notes, "These findings also have implications for primary care practices, where strategies are needed to promote discussion of prostate cancer and personalized decisions about screening options.
"Prior research has examined multimedia aids and other interactive strategies to foster informed decision-making," says Dr. Kripalani. "While generally effective, such approaches may be difficult to implement on a large scale, particularly in health care settings that have limited resources, including many clinics that provide care to underserved minority populations. By contrast, the present approach appears simple and effective, and it could be scaled up at relatively low cost." The article is "Low-Literacy Interventions to Promote Discussion of Prostate Cancer: A Randomized Controlled Trial" by Sunil Kripalani, MD, MSc, Jyoti Sharma, MD, Elizabeth Justice, MD, Jeb Justice, MD, Cynthia Spiker, MPH, Larry E. Laufman, EdD, Terry A. Jacobson, MD, Megan Price, MS, and Armin D. Weinberg, PhD.