Prostate cancer, the most common cancer in men, has a 60 percent greater incidence in African- Americans than whites, and mortality is more than double. Despite a steady decline in mortality since the early 1990s, the disparity in mortality persists, heightening the urgency to address the issue.  

For the past four years, School of Public Health Assistant Professor Ricardo J. Wray, PhD has conducted research assessing prostate cancer needs among African-Americans, including a needs assessment of prostate cancer, care-seeking, and process evaluations of two community outreach projects. This research has shown that community organizations are actively engaged in promoting prostate cancer prevention and have a great deal of potential to change knowledge, beliefs, intentions and behaviors, yet shortfalls exist in promoting informed decision-making.  

Strategies for the primary prevention of prostate cancer have not been found, and secondary prevention via prostate cancer screening remains contentious, as there is no clear evidence that it decreases mortality. The controversy has led some leading medical groups to reject this solution; others have called for efforts emphasizing informed decision-making. Despite the controversy, screenings are seen as one of few areas with potential for reducing disparities.  

In light of the controversy regarding prostate cancer screenings, Dr. Wray’s data points to the pressing need for research on effective approaches that enhance the likelihood that men who are screened do so in an informed manner. In a new NCI-funded study, Dr. Wray aims to develop and assess an educational outreach strategy promoting increased knowledge about prostate cancer and informed decision-making about screenings. The strategy will be designed for use by organizations working in community settings. Educational content will draw on interviews with clinicians, health educators and survivors who are experienced in community outreach. The strategy will include an informed decision-making process as well as survivor testimonies.  

The study seeks to assess the potential to promote informed prostate cancer decision-making in community-based outreach programs, as well as the unique contributions of survivor educators to program effects. A multi-method assessment of program effects on knowledge, beliefs, decision satisfaction and screening intentions will combine qualitative pre-testing and a quantitative quasi-experiment in community settings.  

The study will be designed and implemented as an initiative in partnership with community groups working to improve prostate cancer care among African-Americans in St. Louis. The educational strategy proposed in this application is intended to be a model for use by community organizations. This exploratory research aims to lead to further grant applications for funding by the NCI to conduct a larger quasi-experiment, followed by a field trial of the educational strategy within the context of a survivor-led prostate cancer outreach module. The work is consistent with NCI priorities to support community-based participatory research and to reduce cancer disparities.