Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

Abstract

OBJECTIVES: Ethnic minorities are disproportionately impacted by prostate cancer (PCa) and are at risk for not receiving informed decision making (IDM). We conducted a systematic literature review on interventions to improve: (1) IDM about PCa in screeningeligible minority men, and (2) quality of life (QOL) in minority PCa survivors. DATA SOURCES: MeSH headings for PCa, ethnic minorities, and interventions were searched in MED-LINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. SUBJECT ELIGIBILITY CRITERIA: We identified U.S.-based, English-language articles (1985-2010) on interventions to improve PCa IDM and QOL that included 50 % or more minority patients or analyses stratified by race/ethnicity. STUDY APPRAISAL AND SYNTHESIS METHODS:Articles (n=19) were evaluated and scored for quality using a Downs and Black (DB) system. Interventions were organized by those enhancing 1) IDM about PCa screening and 2) improving QOL and symptom among PCa survivors. Outcomes were reported by intervention type (educational seminar, printed material, telephonebased, video and web-based). RESULTS: Fourteen studies evaluated interventions for enhancing IDM about PCa screening and five evaluated programs to improve outcomes for PCa survivors. Knowledge scores were statistically significantly increased in 12 of 13 screening studies that measured knowledge, with ranges of effect varying across intervention types: educational programs (13 %-48 % increase), print (11 %-18 %), videotape/DVD (16 %), and web-based (7 %-20 %). In the final screening study, an intervention to improve decision-making about screening increased decisional self-efficacy by 9 %. Five cognitive-behavioral interventions improved QOL among minority men being treated for localized PCa through enhancing problem solving and coping skills. LIMITATIONS: Weak study designs, small sample sizes, selection biases, and variation in follow-up intervals across studies. CONCLUSIONS: Educational programs were the most effective intervention for improving knowledge among screening-eligible minority men. Cognitive behavioral strategies improved QOL for minority men treated for localized PCa.

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

“…[2][3][4][5][6] While many valuable ideas to address racial and ethnic health disparities are being pursued outside of the healthcare system, Finding Answers focuses specifically on what can be accomplished once regular access to healthcare services is achieved. Thus, the reviews focused on interventions that occur in or have a sustained linkage to a healthcare delivery setting; programs that were strictly communitybased were outside the scope of the project.…”

“…The prostate cancer review focused on the importance of informed decision making for addressing prostate cancer among racial and ethnic minority men. 6 Educational programs were the most effective intervention for improving knowledge among screening-eligible minority men. Cognitive behavioral strategies improved quality of life for minority men treated for localized prostate cancer.…”

“…Over the past seven years, Finding Answers has funded 33 research projects and performed 12 systematic literature reviews, including the five papers in this symposium. [2][3][4][5][6] We are now beginning to leverage this research base to provide technical assistance to organizations that are implementing disparities reduction interventions, such as those participating in RWJF's Aligning Forces for Quality program. 7 This paper summarizes the major lessons learned from the systematic reviews and provides a disparities reduction framework.…”

Intrapersonal and community factors associated with prostate cancer screening among African-American males in the US

“…10 While evidence for and against PCS is inconsistent, current guidelines fail to address racial and ethnic disparities associated with PCa, and hence, potentially adverse consequences of discontinuing testing for high-risk groups such as AA males. 11 The research used to develop the current guidelines lacked sufficient numbers of AA and other racial/ethnic minorities. 12,13 The purpose of the study is as indicated in the next paragraph.…”

Capsule Commentary on Volandes et al., Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai’i

“…Previous studies suggest they might be helpful with minority populations. 3,4 This intervention was a video decision tool, but one could easily see motivated health systems hosting these videos on their webpages, on their Facebook accounts and even pushing them to patients. As the current, computer savvy generation ages, one can imagine innumerable opportunities for asynchronous communication and education.…”