Purpose: Compared to White men, African American men bear a disproportionate burden of prostate cancer (PCa), including higher mortality, widespread undertreatment, and greater dissatisfaction with care and decisional regret. We explored the process of treatment decision-making to inform future interventions to achieve patient-centered communication and guideline-concordant care.
Methods: We conducted an ethnographic cohort study at two public hospitals following African American men newly diagnosed with PCa, from diagnosis through treatment decision. Data sources included audio-recorded observations of urology and radiation oncology appointments, field notes from observations of multiple clinic appointments, and two in-depth interviews with patients (post-diagnosis and post-treatment decision). We explored how patients chose their treatment, who they consulted, and the information they sought. Audio recordings of clinic appointments and in-depth interviews were transcribed verbatim. We used an iterative process of coding and team discussion to conduct a thematic analysis of qualitative data to examine the experiences, refine codes, and identify key themes.
Results: Among 16 African American men diagnosed with PCa, four key themes emerged regarding treatment decision-making: feelings of anxiety/fear, impact of others' cancer narratives, interactions with clinical team, and sociocultural support. Men expressed a desire to quickly get past PCa due to anxiety/fear and viewed surgery as their best option to achieve this goal. Patients' sense of urgency varied based on diagnosis (low-risk vs. intermediate- or high-risk PCa). Many men reflected on negative things they heard from other people's cancer experience, often not related to PCa, which elevated their own apprehension of certain treatment options. Patients expressed confidence in and level of comfort with their urologist and his/her recommendation, despite the absence of a second opinion or radiation oncology consultation. Notable sociocultural dynamics emerged, such as men hiding their diagnosis from family, and family members questioning care plans (e.g., active surveillance vs. active treatment). Partners, family members, and friends played an important role, despite their absence at clinic appointments.
Conclusions: Study results thus far reveal a range of influences on PCa treatment decision-making among African American men, including fear/anxiety and sociocultural networks that may contribute to rushed and ill-informed decisions. A more nuanced probing of sociocultural aspects is needed. Future studies should further explore these factors as nodes shaping decision trajectories, and therefore as potential points for intervention. For example, educational efforts might highlight the availability of time to consider treatment options and the value of second opinions. PCa survivors' stories could also be a powerful resource, although efforts may need to demystify misinformation that incites fear.
Citation Format: Nynikka R. Palmer, Richard L. Street, Dean Schillinger, Janet K. Shim, Sarah D. Blaschko, Benjamin N. Breyer, Rena J. Pasick. An ethnographic study of African American men's prostate cancer treatment decision-making [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A047.