How African American Men Decide Whether or Not to Get Prostate Cancer Screening

Randy A. Jones, PhD, RN; Richard Steeves, PhD, RN, FAAN; Ishan Williams, PhD


Cancer Nurs. 2009;32(2):166-172. 

In This Article

Discussion and Study Limitations

A number of the participants, particularly the 7 married men, reported that family involvement played an important part in their decision-making process. Other studies[29,30] have also found that spouses played a major part in gathering information and advising on healthcare, and family members were key individuals in the decision-making process in the African American community. The men in this study took into consideration their family's and friends' advice when deciding whether or not to have prostate cancer screening.

Yet, most of these men had limited information about prostate cancer. Many believed that they were not well informed about the disease by healthcare providers and thought that more education about prostate cancer was needed for the public and particularly for individuals at high risk. However, participants also thought that their physicians played an important role through information and recommendations on whether to have prostate cancer screening. Furthermore, participants' decision to have prostate cancer screening was based in part on their trust in healthcare providers.

The limited amount of information the participants (particularly those with less than a high school education) had about prostate cancer is consistent with others. These men were not aware that African Americans are at higher risk for prostate cancer and mortality than other races. Lack of knowledge about the disease may have led in the individuals to believe that they were not susceptible to this potentially serious disease.

The men's decision-making process seemed to be related to the amount of information they had and their trust in family and in healthcare providers. Most of the men said that they trusted their primary health provider, which differs from some previous studies that revealed high mistrust of healthcare providers among African Americans. This may be explained by the fact that some of these men had a long relationship with their provider, and over time, a trusting relationship had matured. The men believed that with adequate information about the disease and trust in their healthcare provider, they could make a good decision. A study that examined patient's desire to gain additional information about their medical condition versus to take an active role in making the actual decision found that more patients preferred to have more information than to take the active role in making the decision.[31] Interestingly, in a study that focused on trust and its effect on decision making, most of the respondents with higher trust in healthcare providers desired a more passive role in decision making than did individuals with lower levels of trust.[32]

Although there are numerous resources available now for cancer prevention and detection, many African American men still do not receive prostate cancer screening.[33] If we are to increase the number of men who are diagnosed early, we must understand how men make decisions about prostate cancer screening. To date, however, few researchers have examined decision making about screening by minority men, who are at higher risk for prostate cancer. Cultural beliefs and previous experiences seem to be important determinants of cancer outcomes, and they may play a role when the diagnosis is made in African American men.

This study provides beginning information on their decision making. However, most of the sample came from individuals who reside in central rural Virginia; they may not be representative of the rural population throughout the United States. Another limitation may be related to self-selection. The participants agreed to be interviewed and were interested in the study and screening. There is still a lack of information on individuals who are not interested in prostate cancer screening. Future studies may want to examine groups of men who lack interest in screening to gain their perspective and experiences with decision making about prostate cancer screening. The study's sample characteristics may also be a limitation to this study due to most of the sample being employed, having some type of insurance, and having had a prostate cancer screening before. Future studies of decision making need to be expanded to different cultures, ethnicities, and geographic locations to ensure more generalizable representation.


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