Hidden barriers between knowledge and behavior: the North Carolina prostate cancer screening and treatment experience.
BACKGROUND
Prostate cancer (PC) mortality is much greater for African American than for Caucasian men. To identify patient factors that might account for some of this disparity, men within 6 months of diagnosis were surveyed about health attitudes and behavior.


METHODS
Using Rapid Identification in the North Carolina Cancer Registry, 207 African American and 348 Caucasian recently diagnosed PC patients were identified and surveyed.


RESULTS
African American men were younger and less often currently married, and had lesser education, job status, and income than Caucasian men (all P < .001). African American men were at no greater distance to medical care, but had less access: poorer medical insurance coverage, more use of public clinics and emergency wards, less continuity with a primary physician, and more often omitted physician visits they felt they needed. They also expressed less trust in physicians. African American men acknowledged their greater risk of PC, accepted greater responsibility for their health, and reported more personal failures that delayed diagnosis. African American men more often requested the tests that diagnosed their cancers, which resulted more often from routinely ordered screening tests for Caucasian men. African American men expressed less interest in nontraditional treatments.


CONCLUSIONS
Despite lesser education, African American men in North Carolina are aware of their increased risk of cancer, the importance of treatment, and their responsibility for their health. Obstacles to timely diagnosis and appropriate care, including greater physician distrust, appear more likely to arise from reduced access and continuity of medical care arising from their worse socioeconomic position.
Talcott
James A
JA
Center for Outcomes Research, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts 02114, USA. jtalcott@partners.org
Spain
Pamela
P
Clark
Jack A
JA
Carpenter
William R
WR
Do
Young Kyung
YK
Hamilton
Robert J
RJ
Galanko
Joseph A
JA
Jackman
Anne
A
Godley
Paul A
PA
D000328:Adult; D001741:Black or African American; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003144:Communication Barriers; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D012042:Registries; D012959:Socioeconomic Factors; D044465:White People