Simple interventions may increase prostate cancer screening

Jul 12 2007

Prostate cancer is the most common cancer in American men, with an estimated incidence of 234,460 cases and 27,360 deaths in 2006. Screening for prostate cancer remains controversial due to insufficient evidence to recommend for or against screening.

In particular, strategies for encouraging discussion of prostate cancer in high-risk populations have not been tested. In a study published in the August issue of the American Journal of Preventive Medicine, researchers examined the effects of two low-literacy interventions on discussions about, and screening tests for prostate cancer.

An inner-city primary care clinic was the setting for this study of 250 men age 45-70 with no prior history of prostate cancer. Over 90% of the subjects were African-American and about 79% read below 9th grade level. Patients received either a detailed educational handout about prostate cancer screening (PtEd group), a simple handout encouraging them to talk to their doctor (Cue group), or a control handout (control group). None of the interventions advocated for or against screening.

After each patient had seen a physician or nurse practitioner, an interviewer (blinded to which intervention had occurred) asked a series of questions about what was discussed with the caregiver. Participants were also assessed for their health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) test. The interviewer also determined whether a Prostate Specific Antigen (PSA) test was ordered that day, or whether a Digital Rectal Exam (DRE) was done.

While 48% of all patients reported discussing prostate cancer, 58% of the Cue group and 50% of the PtEd group reported discussions, against only 37% of the control group. Further, when prostate cancer was discussed, both the Cue group (40%) and the PtEd group (48%) initiated the conversations, compared to only 10% of the control group.

Writing in the article, Sunil Kripalani, MD, MSc, Emory University School of Medicine, notes, "These findings also have implications for primary care practices, where strategies are needed to promote discussion of prostate cancer and personalized decisions about screening options. Prior research has examined multimedia aids and other interactive strategies to foster informed decision-making. While generally effective, such approaches may be difficult to implement on a large scale, particularly in health care settings that have limited resources, including many clinics that provide care to underserved minority populations. By contrast, the present approach appears simple and effective, and it could be scaled up at relatively low cost."

Dr. Kripalani believes the present findings demonstrate ,that such patient interventions are effective across literacy levels, and they work primarily by empowering patients to raise the topic of discussion."