Interventions to improve decision making and reduce racial and ethnic disparities in the management of prostate cancer: a systematic review.
OBJECTIVE
Ethnic minorities are disproportionately impacted by prostate cancer (PCa) and are at risk for not receiving informed decision making (IDM). We conducted a systematic literature review on interventions to improve: (1) IDM about PCa in screening-eligible minority men, and (2) quality of life (QOL) in minority PCa survivors.


METHODS
MeSH headings for PCa, ethnic minorities, and interventions were searched in MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. SUBJECT ELIGIBILITY CRITERIA: We identified U.S.-based, English-language articles (1985 - 2010) on interventions to improve PCa IDM and QOL that included 50% or more minority patients or analyses stratified by race/ethnicity.


METHODS
Articles (n = 19) were evaluated and scored for quality using a Downs and Black (DB) system. Interventions were organized by those enhancing 1) IDM about PCa screening and 2) improving QOL and symptom among PCa survivors. Outcomes were reported by intervention type (educational seminar, printed material, telephone-based, video and web-based).


RESULTS
Fourteen studies evaluated interventions for enhancing IDM about PCa screening and five evaluated programs to improve outcomes for PCa survivors. Knowledge scores were statistically significantly increased in 12 of 13 screening studies that measured knowledge, with ranges of effect varying across intervention types: educational programs (13% - 48% increase), print (11% - 18%), videotape/DVD (16%), and web-based (7% - 20%). In the final screening study, an intervention to improve decision-making about screening increased decisional self-efficacy by 9%. Five cognitive-behavioral interventions improved QOL among minority men being treated for localized PCa through enhancing problem solving and coping skills.


CONCLUSIONS
Weak study designs, small sample sizes, selection biases, and variation in follow-up intervals across studies.


CONCLUSIONS
Educational programs were the most effective intervention for improving knowledge among screening-eligible minority men. Cognitive behavioral strategies improved QOL for minority men treated for localized PCa.
Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
Saleha
S
Sajid
Ashwin A
AA
Kotwal
William
W
Dale
D003657:Decision Making; D019468:Disease Management; D005006:Ethnicity / Q000208:ethnology; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D010358:Patient Participation / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D044469:Racial Groups / Q000208:ethnology; D016032:Randomized Controlled Trials as Topic / Q000379:methods