title: Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives.
abstract: OBJECTIVE
  First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity.
  
  
  METHODS
  A cross-sectional, qualitative study design was used.
  
  
  METHODS
  Study setting was a cancer center in southwest Florida.
  
  
  METHODS
  The study comprised 44 participants (24 PC patients and 20 unaffected FDRs).
  
  
  METHODS
  Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods.
  
  
  RESULTS
  Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than one separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM.
  
  
  CONCLUSIONS
  Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway.
authors: Clement K
authors: CK
authors: Gwede
authors: Stacy N
authors: SN
authors: Davis
authors: Shaenelle
authors: S
authors: Wilson
authors: Mitul
authors: M
authors: Patel
authors: Susan T
authors: ST
authors: Vadaparampil
authors: Cathy D
authors: CD
authors: Meade
authors: Brian M
authors: BM
authors: Rivers
authors: Daohai
authors: D
authors: Yu
authors: Javier
authors: J
authors: Torres-Roca
authors: Randy
authors: R
authors: Heysek
authors: Philippe E
authors: PE
authors: Spiess
authors: Julio
authors: J
authors: Pow-Sang
authors: Paul
authors: P
authors: Jacobsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005190:Family; D005431:Florida; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D036301:Qualitative Research
keywords: Decision Aid; Family History; First-Degree Relatives; Health Promotion; Health focus: social health; Informed Decision Making; Manuscript format: research; Outcome measure: behavioral; Prevention Research; Prostate Cancer; Research purpose: descriptive; Setting: clinical/health care; Strategy: education, skill building/behavior change, and culture change; Study design: qualitative; Target population age: adults; Target population circumstances: race/ethnicity and male first-degree relatives