Patient and Physician Factors Associated with Undisclosed Prostate Cancer Screening in a Sample of Predominantly Immigrant Black Men

Abstract

Medical guidelines do not recommend prostate cancer screening, particularly without informed and shared decision making. This study investigates undisclosed opportunistic screening using prostate specific antigen (PSA) testing in black immigrant and African American men. Participants (N = 142) were insured urban men, 45-to 70-years old. Patients’ reports of testing were compared with medical claims to assess undisclosed PSA testing. Most (94.4 %) men preferred to share in screening decisions, but few (46.5 %) were aware PSA testing was performed. Four factors predicted being unaware of testing: low formal education, low knowledge about prostate cancer, no intention to screen, and no physician recommendation (all p’s <.05). Undisclosed PSA testing was common. Both patient and provider factors increased risk of being uninformed about prostate cancer screening. Interventions combining patient education and physician engagement in shared decision making may better align practice with current prostate cancer screening guidelines.

<p>Physician engagement: a concept analysis</p>

“…Communication is another antecedent that has appeared repeatedly in the literature 3,5,10,57,61,67,71,81–83,85–100. Specifically, two-way communication between physicians and administration,24,58 as well as amongst physicians 45.…”

“…Physician engagement at the macro level refers to involvement in activities at the health system level, activities that extend beyond a single organization. Examples include improved population health and lower costs62 and health system efficiency as a whole,62–65 acting as a facilitator of system transformation58 and health advocacy66,67 such as woman’s health system change,68 their role in community issues such as gun violence prevention,69 and decision-making on tobacco treatments whether for tobacco70 or prostate cancer screening 71…”

“…Accountability has appeared repeatedly in the literature as an antecedent of physician engagement 5,71,79–83. Examples include responsibility for clinical and health outcomes,62 patient outcomes, service utilization and system performance,64 quality, cost and care,60 clinical improvement projects,84 and government and institutional policies to involve doctors in clinical leadership roles 30…”

“…Good working relations are required between physicians and administrations, with the alignment of goals24,52,116,117 values,4,30,82,117,118 and beliefs 119. There needs to be trust3,10,30,98,119 and respect, whereby opinions, ideas, and beliefs are valued,4,81,83 taken into account21 and physicians feel supported 71,120. There needs to be team leadership,86 team building94, and teamwork 3,4,27,48,89,121.…”

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

“…Language and cultural barriers can make it harder for many FB individuals to access information about HIV prevention and where to access HIV screening (129). Second, FB Black men are less likely to have a usual source of care or to utilize general preventive care services (130,131), and are therefore less likely to have routine HIV screening offered, with the exception of men who are currently incarcerated and receive mandatory HIV screening (132,133). A lack of familiarity with how to navigate the US health care system and system of Medicaid entitlements is another key barrier to accessing HIV prevention and screening services (134).…”