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Cancer Control Research

Lepore, Stephen J.


DESCRIPTION (provided by applicant): Relative to other racial and ethnic groups, African American men have a higher prevalence of cancer of the prostate (CaP), are more likely to present with disease at later stages, often have more aggressive tumors, are more likely to die from CaP, and tend to be less knowledgeable about CaP risk and the potential harms and benefits of CaP screening. There is no national consensus on screening for CaP, but practice guidelines recommend educating men, especially high-risk men, about the benefits and harms of CaP screening to support men in making informed decisions about CaP screening. The proposed study aims to: (a) evaluate the efficacy of a tailored telephone intervention in increasing knowledge and skills among African American men related to making an informed choice about CaP screening, (b) identify mediators and moderators of the intervention, and (c) explore predictors of CaP screening to understand why men decide to screen or not. The target population is African American men between the ages of 45 - 70 years old enrolled in the 1199 National Benefit Fund, the health care insurance fund for the largest health care workers union in the United States. Five hundred eligible and consenting men will receive a print brochure on the advantages and limitations of CaP screening and will then be randomized to receive either tailored-telephone CaP screening education or placebo (attention control) telephone education about diet and cancer risk. The tailored-telephone education program is designed as a decision support intervention and is based on the Ottawa Framework of medical decision-making. Main study outcomes are CaP decision variables (patient decision conflict, congruence between patient values and CaP screening decision) and communication variables (patient discusses CaP with physician and shares in CaP screening decision). Other important outcomes include knowledge about CaP and screening, perceived decision support, and perceived efficacy to communicate with physician. Data will be collected through patient interviews, physician reports, and medical chart and claims review at baseline and 6 -months post-intervention. This proposal addresses the strong need to educate African American men about CaP screening as a way of enhancing individualized, informed and shared decision making regarding CaP screening. By ensuring that the intervention components are theoretically grounded, acceptable to the target population, feasible in terms of time, practical, and allow for individualization, the proposed intervention strategy has the potential to be widely disseminated if efficacy is demonstrated.

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