Prostate Cancer Screening in the African American Community: The Female Impact

Purpose: This presentation reports findings from a qualitative exploratory study aligned with the Healthy People 2020 goal of reducing the prostate cancer death rate and the resultant health disparity in African American men (Office of Disease Prevention and Health Promotion [ODPHP], 2017). The study addressed the following research question: “Do women impact African American men’s decision to participate in prostate cancer screening?” Background: Prostate cancer is the second most common cancer diagnosed in men. In 2012, an estimated 1.1 million cases were diagnosed worldwide with an estimated 307,000 cases resulting in death (Ferlay et al., 2015). Incident and mortality rates are generally higher in populations of African descent. African American men are among the highest prostate cancer rates in the world (Seigal et al., 2016). The National Cancer Institute (NCI) reported that African American men are 60% more likely to develop prostate cancer and 2.4 times more likely to die as a result of the disease than Caucasian men (2014). One reason for this disparity is that African Americans are more likely to be diagnosed at later stages of the disease which leads to less treatment options, higher morbidity and mortality rates (DeSantis et al, 2016). Some have suggested that separate prostate cancer screening guidelines are needed specifically for African Americans (Shenoy et al., 2016). There is, however, a consensus among the scientific community that men should be informed of the benefits and know the risks and limitations of screening in order to make an informed decision regarding participation in prostate cancer screening (Smith et al, 2016). Eastland and Dancy (2013) proposed that women play a key role in communicating information to increase men’s knowledge of prostate cancer screening. A previous study by Eastland (2016) indicated that African American women desire to be actively involved in prostate cancer screening discussions. However, the women in the study felt that the men’s attitude could be a barrier to successfully influencing taking action for screening. Since the women could only speculate on their possible influence on the men’s choices, the next step was to explore the views of African American men in regards to how women impact their prostate cancer screening decision. Methodology: A qualitative exploratory research approach was used to conduct in-depth interviews with 10 African American men. The semi-structured interviews were conducted using an interview guide developed by the primary investigator that consisted of 10 open ended question and probes. The interviews were conducted at various locations in the community and lasted 15-30 minutes. The collected data was audio-taped, transcribed verbatim and analyzed using thematic content analysis to identify emergent themes. Findings: Most of the men in this study reported that they would include their wife or long-term girlfriend in their health decisions. The analysis of the data collected during the course of the study suggested that women may have an impact on men’s prostate cancer screening decisions. Three major themes were identified that determined the degree of that impact: “health knowledge”, “relationship” and “male ego”. The men reported that the more prostate cancer knowledge the women possessed and the more loving the relationship the greater the degree of the impact. However, the men stated that the impact could be lessened by issues of masculinity. Significance: The findings of this study provide insight into the impact women have on African American men’s decision making process regarding prostate cancer screening. These findings are consistent with the best available current evidence. Women may be vital to helping men with making screening and health decisions (Hunter et.al., 2015; Manne et al., 2012), Having this understanding will enable future research to link influences on participating in prostate cancer screening with evidence-based nursing interventions for informed decision making process. Additionally, these findings suggest implications regarding the feasibility of engaging women in other health disparities affecting African American men globally.