INTRODUCTION
METHODS
Initial Search
Inclusion/Exclusion Criteria
Article Selection (Figure 1)
Quality and Bias Assessment
Data Extraction and Synthesis (Tables 1, 2)
Reference | Design | Sample Size (N), Ethnicity | Duration, Follow-up | Content*
| Outcome(s) | Results | DB Score ** |
---|---|---|---|---|---|---|---|
EDUCATIONAL PROGRAM INTERVENTIONS
| |||||||
Boehm et al. 1995 20
| Pre-test/Post-test |
N = 123 | Same day |
ES: Educational session using AA PCa survivors to teach PCa knowledge and self-efficacy. Focus group used for development of measures |
K: 11-item scale (anatomy, physiology, PCa risks, benefits of early detction, methods of screening, signs of PCa). |
K: 13 % PCa screening knowledge score increase pre vs. post (p < 0.01) with mean test score improving from 8.7 to 10.1 | 19 |
AA: 100 % | |||||||
Collins et al. 1997 22
| Pre-test/Post-test |
N = 75 | Same day |
ES: Pretest questionnaire, followed by an educational session, then a post-test questionnaire |
K: 7-item PCa Knowledge Scale (Developed from American Cancer Society [1992] "For Men Only" Pamphlet) |
K: 46 % increase in knowledge scores pre vs. post (21 % to 67 %, no CI or p-value provided) | 14 |
AA: 100 % | |||||||
Powell et al. 1997 26
| Cohort |
N = 1,105 | Same day |
ES: Education and recruitment intervention for effective communication on PCa screening in AA men |
K: 11-item PCa knowledge inventory. |
K: PCa knowledge score on 11-item questionnaire increased from 8.7 to 10.1 (p < 0.001) | 14 |
AA: 100 % | |||||||
Wilkinson et al. 2003 30
| Pre-test/Post-test |
N = 900 | Same day |
ES: 1 hour culturally-sensitive education seminar with audiovisual materials to promote informed decisions |
K: 12-item PCa scale (PCa symptoms, incidence, screening beliefs, detection, treatment, mortality, side effects from treatment, foods, Responses: multiple choice) |
K: 47 % increase in post-seminar PCa knowledge score over pre (26 % ± 17.7 % to 73 % ± 22.1 %, p < 0.01) | 19 |
AA: 100 % | |||||||
Husaini et al. 2008 31
| RCT |
N = 430 (At 3-mo follow up, N = 350), AA: 100 % | Same day |
ES, V, PM: Culturally-tailored educational intervention, including a video, pamphlet, and Q&A sessions. Early (intervention) vs. late (control) |
K: 6-item PCa Knowledge Scale (True/false, 0-6 Score), O: Patient Physician PCa Screening discussion (at 3 months) |
K: No significant differences. O: Intervention group relatively more likely to talk to physician about PCa screening than control (OR = 2.01, p < 0.05) | 25 |
Holt et al. 2009 25
| RCT |
N = 49 | Same day |
ES, PM: Spiritual vs. Non-spiritual, educational IDM intervention—print materials and 1-hour class |
K: 9-item scale (PCa risk factors and knowledge, previously validated scale), 4-item scale (knowledge of PSA controversy), Single-item (Awareness of if screening can prevent PCa mortality). SE-D: 2-item IDM about screening, 8-item screening barrier scale, 10-item preparation for decision-making scale |
K: Relative increase in PCa knowledge in both groups over control: spiritual post-test M = 2.15 (SD = 1.75), p < 0.05, non-spiritual post-test M = 1.82 (SD = 1.08), p < 0.05; SE-D: relatively increased decision making self-efficacy for PSA screening in spiritual group over control [mean = 0.55 (SD = 1.18) vs. mean = 0.44 (SD = 1.46); p < 0.05] | 21 |
AA: 100 % | |||||||
Carter et al. 2010 21
| Pre-test/Post-test |
N = 405 (At 3-mo follow-up, N = 204), AA: 100 % | Same day, Follow-up at 3 months |
ES: Educational session with focus groups, 13 modules focused on PCa knowledge, screening, treatment, empowerment, and health insurance |
K: 15 item PCa scale (total score not reported). |
K: Increase in PCa knowledge (by 85 %-total score change not available) in questions on PCa incidence, ethnic disparity, PSA and DRE use, sexual function side effects mortality, causes, and insurance over control (p < 0.01, CI not provided) | 17 |
Drake et al. 2010 23
| Pre-test/Post-test |
N = 73 | Same day |
ES: Education session on IDM SE-D, and control of decision process |
K: 17-item PCa knowledge scale (validated, 0 – 100 % score), SE-D: 11-item Decision Self-Efficacy Scale (standardized scores of 0 – 100), D-C: 9-item validated decisional conflict scale, (standardized 0 – 100 score), O: Control Preference Scale |
K: 25.7 % increase pre vs. post (p < 0.01); SE-D: 8.9 point average relative increase (83.6 to 92.5, p = 0.025). D-C: no significant difference. O: men wanted to be more involved in screening decision making post-intervention compared to control (16.4 %, p < 0.01) | 20 |
RINTED MATERIALS/BOOKLETS
| |||||||
Taylor et al. 2006 28
| RCT |
N = 238 | Baseline, 1 month, 1 year |
V, PM: Videotape or booklet to inform men of PCa screening controversy. Three groups: video, booklet, and control |
K: 11 item scale from NCI Cancer Fact Sheet on PCa (Questions on symptoms, controversy risk factors, test limitations, and PCa treatment course. D-C: 10-item decisional conflict scale |
K: Print—11.8 % relative increase in total score compared to control [p < 0.001], D-C: relatively reduced D-C in Print (OR = 0.098, 95 % CI: 0.04 – 0.26) compared to control. Print more successful than Video (OR:0.21, CI: 0.09 – 0.52) | 22 |
AA: 100 % | |||||||
Kripalani et al. 2007 18
| RCT |
N = 250, AA: 90.4 %, White: 8.0 %, Other: 1.6 % | 6 months |
PM: Patients given 1) a neutral educational PCa handout (PtEd), 2) a simple handout encouraging PCa discussion (Cue), or 3) a control handout |
SE-D: Patient-Physician PCa Discussion |
SE-D: Increased discussion rates in Cue handout (58 %; OR = 2.39, CI = 1.26 – 4.52) and PtEd handout (50.0 %; OR = 1.92, CI = 1.01 – 3.65) vs. control 37.3 %; patient-initiated discussion increased at 6 months (47.6 % PtEd: 40 % Cue, vs. 9.7 % control, p < 0.01) | 25 |
Stephens et al. 2008 27
| RCT |
N = 400; AA: 50 % | Same day |
PM: Patient given printed decision aid designed by CDC. Information on PCa, mortality from PCa, PCa screening risks and benefits, and importance of MD discussion |
K: 24-item scale based on previous work and content of decision aid. D-C: Decsional Conflict Scale, 5 sub-scales—uncertainty, feeling uninformed, feeling unclear, feeling unsupported, quality of the decision. |
K: 24-item scale based on previous work and content of decision aid. Knowledge improved with DA use in AA (17.5 to 20.6; p < 0.001). D-C: Decision aid lowered decisional conflict (indirectly through improved knowledge). | 25 |
TELEPHONE/VIDEOTAPE/DVD
| |||||||
Barber et al. 1998 19
| Pre-test/ |
N = 944, White: 51.6 %, AA: 43.6 %, Hisp: 1.3 % | Same Day |
V: Videotape educational intervention stressing importance of PSA & DRE screenings, free screenings provided |
K: questionnaire (unclear number of questions, on PCa knowledge, attitudes on screening. Responses: True/False or multiple choice. Max score 7) |
K: 26.7 % increase in overall score in AA and whites pre vs. post [mean increase from 4.61 to 5.84 (p < 0.01)] | 18 |
Post-test | |||||||
Taylor et al. 2006 28
| RCT |
N = 238 | Baseline, 1 month, 1 year |
V, PM: Videotape or booklet to inform men of PCa screening controversy. Three groups: video, booklet, and control |
K: 11 item scale from NCI Cancer Fact Sheet on PCa (Questions on symptoms, controversy risk factors, test limitations, and PCa treatment course.) D-C: 10-item Decisional Conflict Scale; O: Satisfaction with decision |
K: Video—18.1 % increase in total score compared to control [p < 0.001]; D-C: relatively reduced D-C in Video (OR = 0.46, 95 % CI:0.21 – 0.99) compared to control. O: No difference in satisfaction about screening decision. | 22 |
AA: 100 % | |||||||
WEB-BASED
| |||||||
Weston et al. 2007 29
| Pre-test/Post-test |
N = 43 | Same day |
W: Computer assisted instructional (CAI) model to increase PCa knowledge and awareness. Focus groups for education provision |
K: 21-item PCa knowledge scale (risk, racial disparities, treatment options, screening risks and benefits, intention), D-C: 16-item Decisonal Conflict Scale (5 subscales—certainty, feeling informed, clear values, support, quality of decision), 11-item Screening Benefits, Risks, and Congruence Scale, O: Patient-Physician discussion of appropriate screening (validated 4-item cognitive approach scale) |
K: 3.8 point increase pre vs. post (47.7 to 51.5, p < 0.01) with CAI intervention; D-C: No statistically significant results, O: No statistically significant differences. | 19 |
AA: 100 % | |||||||
Ellison et al. 2008 24
| RCT |
N = 87 | Same day |
W: Enhanced or usual care (control) neutral web-decision aids related to PCa screening |
K: 12-item PCa screening scale (PCa symptoms, treatment side effects, screening age guidelines. Responses: true/false/don't know) |
K: 7.4 % relative increase (p < 0.01) in knowledge score for enhanced web-based decision aid [mean = 7.67, 63.9 % score (SE = 0.25)] vs. usual care [mean = 6. 78, 56.5 % score (SE = 0.23)] | 21 |
AA: 100 % |
Reference | Design | Sample Size (N), Ethnicity | Duration, Follow-up | Intervention Content* | Outcome(s) | Results | DB Score ** |
---|---|---|---|---|---|---|---|
EDUCATIONAL INTERVENTIONS
| |||||||
Penedo et al. 2004 34
| RCT |
N = 92, Non-Hispanic white: 35 %, Hispanic: 34 %, AA: 22 % | 10 weeks |
ES: Random assignment to either 10-week cognitive behavioral stress management (CBSM) or 1 day seminar (control) |
QOL: 27 item Functional Assessment of Cancer Therapy—General (FACT-G) Scale (4 domains—physical, social, emotional, functional, 5 pt Likert scale, validated, Max score 135), 17-item Measure of Current Status (MOCS) Scale (Stress-management skill) |
QOL: 3 point post-intervention increase in FACT-G (87.3 to 90.5, p < 0.01); 3.7 point increase in stress-management skills in intervention group compared to control (63.3 to 67.0, p < 0.01) | 23 |
Penedo et al. 2007 44
| RCT |
N = 71, Hispanic: 100 % | 10 weeks |
ES: Random assignment to either a 10-week cognitive behavioral stress management (CBSM) with psychosocial batteries, workbooks or a seminar (control) |
QOL: 27 item Functional Assessment of Cancer Therapy—General (FACT-G) Scale (4 domains—physical, social, emotional, functional, 5 pt Likert scale, validated, Max score 135; Expanded Prostate Cancer Index Composite (EPIC) 3-item sexual function subscale (0 – 12), |
QOL: CBSM group with absolute increases in total well-being (β = -0.23, p < 0.01); physical well-being (β = 0.408, p < 0.01); emotional well-being (β = −2.44, p < 0.03); sexual functioning (β = −0.014, p = 0.05) compared to control after 10 weeks | 24 |
TELEPHONE/DVD/VIDEOTAPE INTERVENTIONS
| |||||||
Mishel et al. 2002 37
| RCT |
N = 239, AA: 44 %, White: 56 % | 8 weeks, Follow up at 4 months and 7 months |
T: Nurse-delivered psychoeducational intervention to improve uncertainty and symptom control by weekly phone calls to men with localized PCa shortly after surgery or radiation therapy. Three groups: patient alone, patient and family, and control. |
K: 21-item Cancer Knowledge Scale (True/False), SE-S: 26-item Uncertainty in Illness Scale (validated, 1 – 5 Likert scale), 10-item problem solving scale (define concerns and generate solutions, 1 – 10 scale), 9-item Cognitive reframing (view concerns as manageable, 1 – 10 scale) 15-item Symptom Distress Scale (total symptoms and intensity of symptoms on 1 – 5 scale), O: 5-item Patient-Provider communication scale (Degree of communication with provider, 1 – 5 scale) |
K: No change. SE-S: Uncertainty—relatively improved management in intervention groups (p = 0.01), Problem solving—relatively improved at 4 month in intervention (p < 0.05); Cognitive reframing -relatively improved in intervention group at 4 month (P = 0.009); Symptom distress: relative decrease in overall symptoms reported at 8 weeks (p = 0.05), but no difference at 4 months or 7 months; improved incontinence (p < 0.03); improved sexual satisfaction at 4 months (P < 0.02) for AA intervention compared to AA control. O: No change. | 20 |
Campbell et al. 2007 35
| RCT |
N = 40; AA = 100 % | 6 weeks |
T: Telephone-based sessions of coping skills training (CST) for AA PCa survivors and spouses |
QOL: 50-item Expanded Prostate Cancer Index (EPIC) Scale (4 symptom domains—urinary, bowel, sexual, hormonal). Domain scores on 1 – 100 scale), Short Form—36 (SF-36) Health Survey general health scale. SE-S: Self-efficacy for Symptom Control Inventory (3 sub-scales: symptom management, physical function, coping) |
QOL: EPIC Scale—compared to control, relatively improved QOL related bowel symptoms [p < 0.05], hormonal symptoms [p < 0.05] (relative effect); SF-36 Scale—no statistically significant differences. SE-S: improved physical function self-efficacy compared with control [p < 0.05], no other differences. | 23 |
Mishel et al. 2009 38
| RCT |
N = 256; AA:28.5 %, White:71.5r% | 8 weeks, Follow up at 4 month and 7 months |
V, T, PM: Decision-making uncertainty management intervention (DMUMI) for early stage PCa patients, with DVDs, telephone calls, and booklets. Three intervention groups; direct (TD), supplemental (TS), and control. |
K: 20-item Cancer Knowledge Scale. SE-S: 10-item problem solving scale; 35-item Profile of Mood States, short form. O: 5-item Patient-Provider Communication Scale; Medical Communication Competence Scale; 3-item Decisional Regret Scale. |
K: Improved at 1 months (p = 0.001). At 3 mo: 3.5 % improvement in TD vs. control and 4.0 % improvement in TS vs. control. SE-S: improved at 3 months (p = 0.05). O: Communication competence improved in TD and TS vs. control@ 3 months (p = 0.01). | 20 |