Family Cancer Communication Among Black Prostate Cancer Survivors and Their Sons

Rationale: Prostate cancer (PCa) is ranked as the predominate type of cancer among men and second among all cancer types for women and men in the United States (U.S.) [1]. In particular, African American (AA) men, experience a 60% greater incidence and a 2.5 times greater mortality rate from PCa compared to any other race [1]. Cancer communication is recognized as a priority in public health and it’s essential for improving prevention, detection, and treatment rates, as well as the survivorship experience [2-4]. Empirical literature reveals cancer and specifically PCa is a stigma cloaked in misconceptions and not openly discussed within AA families [5-7]. Non-communication of cancer information perpetuates an environment for negative health outcomes and generations without knowledge of their familial risks of cancer. The trait of topic-avoidance and non-disclosure permeates the AA community [5]. An examination of cancer communication among AA’s is a vital concept due to this population’s history of decreased rates of engaging in preventative health behaviors [8]. The health disparity of PCa among AA men necessitates research to examine and identify barriers and facilitators of cancer and health promotion communication. Opening a dialogue among AA PCa survivors regarding their health behaviors, screening, diagnosis, and experience with cancer can serve as the impetus to motivate younger generations to become active participants in their health care. Family communication is considered a salient factor in health-related communication between cancer patients and others [9]. Patients primarily determine the flow of cancer-related communication within the family [9]. Communication in itself can be considered as a fluctuating concept wherein families can use it to assist with cohesion and issues of flexibility [10]. Through research on factors which examine and stimulate cancer and health promotion communication an environment can be created that encourages and empowers communication among Black men and their families experiencing PCa.

Specific Aims: The proposed study will serve as a platform to examine cancer and health promotion communication, which will result in the development of culturally tailored interventions to reduce the health disparity of PCa among the Black diaspora of men. Acquisition of the award will facilitate the examination of psychosocial and psychological factors that promote or impede the transmission of cancer and health promotion communication among Black male survivors and their families. Aim 1: Explore barriers and motivators of communication and health promotion communication among Black men and their sons. Aim 2: Identify factors which impede or promote cancer communication among Black men, their sons, and families. Aim 3: Assess differences in patterns of family cancer communication among the Black diaspora.

Methods: The study is a mixed method design to address the health disparity needs for PCa survivors of the Black male diaspora through the context of family cancer and health promotion communication. The purpose of the study is to concurrently collect data from the Black diaspora of PCa survivors and their sons for the existence and differences in cancer and health promotion communication. Findings will generate data to create interventions for cancer and health promotion communication among the Black diaspora. To address the diaspora of Black men, AA, West African, and Caribbean men will be eligible to participate in the study.

Inclusion criteria consists of Black survivors of PCa, who are able to read and speak English, and have a son over the age of 18 years without a diagnosis or history of PCa. Additionally, the son must be willing to participate in the study. After approval from the University’s institutional review boards, participants will be recruited from Black churches, organizations, and barber shops in the surrounding counties. Methodology for Aims 1 and 2: A qualitative design using focus groups will yield data for Aims 1 and 2 of the study. A total of 30 fathers (PCa survivors) and 30 sons will be the target sample for the study. The fathers and sons will be separated to participate in their own focus groups. Each group will be comprised of only fathers or sons wherein they will meet concurrently to discuss barriers and facilitators of cancer and health promotion communication in their families. Each focus group of fathers and sons will meet for four separate sessions to achieve data saturation. Reoccurring and common themes will be derived from the data as well as individual excerpts from the father and son participants. A Black PCa survivor and advocate will be selected to be present during the father focus groups. The PCa survivor/advocate will undergo training provided by the investigators regarding qualitative research and focus groups. The inclusion of the Black PCa survivor/advocate will assist in encouraging participants to share their experiences and feel a sense of comfort with a known PCa advocate. The Family Cancer and Health Communication questionnaire, developed and previously piloted by the primary investigator, will be distributed to all participants during the initial focus groups of fathers and sons. Demographic data will be collected to examine means and descriptive data. Chi square analysis will assess for differences among the groups and reliability and validity tests will yield psychometric properties of the instrument. The sample will not create sufficient power for analysis, however the findings will produce psychometrics for improving the instrument.

Relevance: The proposed research addresses a gap in the literature regarding cancer communication and specifically PCa communication among Black men and their families. The diversity of the Black diaspora necessitates research on the differences in overall communication, cancer and health promotion communication among Black families experiencing PCa. Benefits from the data will serve to improve informed decision making for PCa screening among unaffected relatives and the quality of life for PCa survivors and their relatives. The findings will produce intervention studies to promote cancer and health promotion communication among Black families.