Barriers and Facilitators to Informed Decision-Making About Prostate Cancer Screening Among Black Men

Nicholas Shungu; Katherine R. Sterba

doi:10.3122/jabfm.2021.05.210149

Article Figures & Data

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Table 1.

Focus Group Participant Characteristics (N = 21)

Characteristic	%
Age, median, in years (range)	61 (55 to 69)
Highest level of education
Did not complete high school	14.3
High School/GED	38.1
Junior college/community college	28.6
Bachelor's Degree	14.3
No response	4.8
Partner status
Married/Partnered	47.6
Divorced/Separated	14.3
Widowed	4.8
Single	28.6
No response	4.8
Knows family member/friend who has been diagnosed with prostate cancer
Yes	61.9
No	38.1
Has talked with a doctor about prostate cancer screening
Yes	61.9
No	38.1
Has been screened with a PSA blood test
Yes	47.6
No	52.4

GED, general education diploma; PSA, prostate-specific antigen.

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Table 2.

External and Intrinsic Factors Impacting Informed Decision-Making

Theme	Definition	Quote
External factors
Interpersonal influences	Impact of important referent individuals on an individual's opinions or beliefs about his health. Includes both direct communication and hearing stories of what has happened to friends/family	“Well, you know, I think… I think I'd go through it (prostate cancer screening), only for the knowin' so many people that's went through it, and talking to them.” (FG2) “I think my father died from prostate cancer if I'm not mistaken…And um, I've got a good friend of mine, um, he say now any time after 55 its almost, like, imperative that you get screened for prostate.” (FG1)
Clinician communication	Impact of clinician on a man's behavior or understanding.	“We will accept that whatever our doctor tell us,..and if they don't say anything, we just say well that's cool. Everything alright. We just will accept what our doctor says.” (FG5) “Well, I mean, pretty much mine just recommended havin' the test.” (FG2)
Intrinsic factors
Pride^*	A feeling of manhood encompassing the importance of strength, virility, and not wanting to burden others	“[Erectile dysfunction as a side effect of prostate cancer treatment] would be devastating to me. I got a wife at home, you know (laughter). And if that were to happen to me, shit, I mean, I don't know. You know, you think about yourself less than a man.” (FG1) “They don't wanna see you in no pampers, you know? That turns off everything!” (FG2)
Care avoidance^*	Failure to care for oneself or seek medical care even if one has the agency to do so	“Some of these people just not used… they get raised up in families that never go to doctors. And I'm being serious. I grew up with plenty of people that didn't go to doctors.” (FG3) “I came from a culture of men who didn't go to doctors. My wife talk to me about it, but I go to the doctor way more than most men I know.” (FG4)
Motivated by racial disparities^*	Black men are motivated to seek additional health information or to change health behaviors due to their knowledge of health disparities	“I mean with the [knowledge that prostate cancer disproportionately impacts Black men] they probably would come get screened. You know. They would deal with that risk.” (FG2) “It's sad that… the Black numbers [of participants in research studies informing prostate cancer screening knowledge] are that low that y'all can't even really give us the information that we really need.” (FG3)

FG, focus group.
↵* Indicates code that was added during the iterative codebook review process

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Table 3.

Beliefs Impacting Informed Decision-Making

Theme	Definition	Quote
Inadequate care from medical community	Men believe that the care provided to them is insufficient or substandard, or men believe that the information provided to them by the medical community is incorrect or not applicable to their personal situation	“So yeah, your burden is basically to be able to get more doctors out there talking to their older Black male patients about what their options are and delivering the information they need so that they can make a choice…And I think that, in turn, would bring down the death pattern from the mere fact that you offered intelligent Black men, which most of us are, damn it, a choice in choosing what they do for their health.” (FG4) “And um mostly a lot of Afro-American people are thinking that when you go to the doctor they are thinking about sometimes they experiment on you. You know, from back in the days..so they kinda cautious about that.” (FG1)
Perceived barriers	A man's feelings on the obstacles to completing prostate cancer screening	“I can say from being like an athlete or whatever, you know, to me, you know, I'm raised… don't nothin' go up there [rectum], everything comes out. You know what I'm saying? That's… that's another kinda stigma that plays in the mind.” (FG4)“For a lot of us, especially Black men, a lot of us don't have health insurance or the money to go to the doctors.” (FG4)
Perceived risk	A man's perception of his susceptibility for developing prostate cancer or developing complications related to PSA testing. Also includes a man's perception that something is physically wrong.	“Maybe down the road or if I see these symptoms [frequent urination, getting up at night to urinate] flaring up or happening, I'll be more inclined to go get screened, cause now I know that there is something going on, you know.” (FG4)“Actually my brother, my brother, he had [prostate cancer] he was in the service. He went to the VA and they got, you know, he got it taken care of. That's why I was wondering that…my brother is younger than me, you know. He is 60. You know, he is younger than me and we may need to attempt the things he's been telling me.” (FG1)
Perceived severity	A man's feelings on the seriousness of contracting prostate cancer	“[Cancer will] take you out. It will take you out. No doubt about it.” (FG4)
Perceived benefits	A man's perception of the positive outcomes derived from completing prostate cancer screening	“I've also heard that prostate cancer, if caught early, detected early, it's one of the more curable cancers, so that's something that you might want to know so you can have that knowledge to save your life…I want to be here for other people, my grandchildren and my children, so at this point in my life I'm trying to help other people…and I think I need to be here to do that.” (FG4)

FG, focus group.

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Table 4.

Identified Target Areas for Facilitation of Informed Decision-Making

Theme	Definition	Quote
Lack of knowledge	A man not possessing sufficient information about prostate cancer screening to make an informed decision.	“Can't make an informed decision if you are not informed. That's the bottom line.” (FG4) “And I've been to a bunch of doctors over the years, well, especially over the past 10 years. You know, and, not once has anyone ever brought up prostate health or screening.” (FG4)
Key take-aways from education session^*	The concepts that men felt were most important or surprising after observing a short presentation on prostate cancer screening in Black men	“I didn't know prostate is this deep! I though we was gonna talk about the screening and the enlargement and that, but you talk about erection and leakin' and diaper and…perspective [of] loved ones.” (FG3) “You can live and be unhappy [due to erectile dysfunction from treatment], or you can choose [not to be screened for prostate cancer]. Just a choice you have to make. With what counts most to you.” (FG2)
Areas of confusion^*	Misstatements by men regarding prostate cancer screening	“And I walked in here basically thinking I knew pretty much everything there was. But come to find out, I skipped a test that I didn't know about and I could be taking these colonoscopies for years and still turn up with prostate cancer.” (FG4) “I heard you, uh, have to take… have to drink something the night before. And then they put you under and screen by going up in there, right? Some kind of way. Get some kind of sample or whatever.” (FG2)