Prostate cancer (PC) is the most commonly diagnosed cancer in men. African Americans (AA) have the highest incidence and mortality of PC among all racial groups in the United States. The prostate-specific antigen (PSA) screening for early detection of PC is highly controversial because it may cause more harm than benefit. As a result, most expert groups recommend shared decision making (SDM). In SDM, the partnership between doctor and patient facilitates the latter’s understanding of pertinent medical information so as to enable him to weigh his values and preferences regarding various options and to engage in active decision making to the extent he feels comfortable.
Although clinicians feel that SDM is appropriate regarding PSA screening, most primary care physicians (PCPs) routinely order a PSA test with little or no discussion about the patient’s belief as to whether the potential benefits justify the risk of harm. Insufficient understanding of epidemiological concepts or of the specific trade-offs associated with PSA screening, lack of time, difficulty eliciting a patient’s values and preferences, and a perceived inability to adequately inform patients about complex decisions are some of the barriers to SDM from PCP’s perspective. Numerous previous decision aids for PSA screening for patients have been reviewed, but there are few studies that involved both clinicians and patients in the SMD in PSA screening. Thus, we propose to engage our patients, PCPs, and other stakeholders (e.g., family, community, payers) in cultivating strong relationships among key stakeholders and researchers in order to identify research questions and goals they consider truly important.