Self-Reported Reasons Men Decide Not to Participate in Free Prostate Cancer Screening

Transcription

1 This material is protected by U.S. copyright law. Uauthorized reproductio is prohibited. To purchase quatity reprits, please or to request permissio to reproduce multiple copies, please ONLINE EXCLUSIVE Dowloaded o Sigle-user licese oly. Copyright 2018 by the Ocology Nursig Society. For permissio to post olie, reprit, adapt, or reuse, please pubpermissios@os.org Self-Reported Reasos Me Decide Not to Participate i Free Prostate Cacer Screeig Sally P. Weirich, PhD, RN, FAAN, Marti C. Weirich, PhD, Julie Priest, MSPH, ad Cathy Fodi, RN Purpose: To determie the reasos why me fail to participate i a free prostate cacer screeig. Desig: Survey ad secodary aalyses usig correlatioal desig. Settig: Commuity sites i the Southeaster Uited States. Sample: The sample (N = 241) raged i age from years. Mea age was 50 years (SD = 7.4). Most of the me were Africa America (79%) ad married (70%). Almost half of the subjects (44%) eared betwee $9,601 ad $,020 per year. Method: Telephoe survey of me who did ot participate i iitial prostate cacer screeig after educatioal program. Mai Research Variables: Demographics, self-reported reasos me decided ot to participate i a free screeig followig a prostate cacer educatioal program, ad predictors for subsequet participatio i screeig. Fidigs: The mai self-reported reaso for ot participatig i a free prostate cacer screeig opportuity was time problems. A sigificat relatioship betwee icome ad physicia problems existed amog the me who did ot participate. Twety-oe percet of the 241 me participated i a secod opportuity for free prostate cacer screeig. Me who cited lost packet as their reaso for ot participatig i the first free screeig were more tha twice as likely to go for the secod opportuity for free screeig whe offered aother packet or voucher for a free screeig with their physicia of choice. Coclusios: Time problems was the most frequet self-reported reaso me gave for failure to participate. Providig a follow-up phoe call ad vouchers a secod time for reimbursemet of the cost associated with a screeig icreased participatio. Me ofte eed assistace with locatig physicias ad urse practitioers who will file for fiacial reimbursemet. Appoitmet remiders are critical. Implicatios for Nursig: The fidigs of this study of the sigificat relatioship betwee icome ad physicia problems for ot participatig has implicatios for healthcare providers. Future programs could provide telephoe follow-up with me ad r vouchers, as eeded. I additio, me could be ecouraged to desigate oe place i their households for health-related papers (for safekeepig). A frica America ad low-icome me, who are at high risk for prostate cacer icidece ad mortality, ofte do ot participate i prostate cacer screeig. Little iformatio is kow about the reasos for failure to participate from the perspective of the me. Key Poits... Ecoomic cost ad lack of kowledge of prostate cacer screeig are major barriers to regular screeig. The most frequet reaso give for ot participatig i first screeig opportuity was time problems. Me with low icomes are more likely to report physicia problems as the reaso for ot participatig i the first screeig. Africa America me ad me with low icomes ofte eed assistace with accessig health care eve whe the cost of the health care is covered. Literature Review Prostate cacer screeig icreased sigificatly atiowide i the 1990s. However, Africa America me were less likely tha Caucasia me to participate i prostate cacer screeig (Mettli, Murphy, Rosethal, & Mech, 1998). Ufortuately, Africa America me have the highest icidece ad mortality from prostate cacer, with a icidece rate of i Africa Americas versus i Caucasias per 100,000 (Jemal, Thomas, Murray, & Thu, 2002; Ries et Sally P. Weirich, PhD, RN, FAAN, is a professor i the School of Nursig at the Uiversity of Louisville i Ketucky ad a research professor i populatio studies at the Uiversity of South Carolia s Cacer Ceter i Columbia; Marti C. Weirich, PhD, is a professor of iteral medicie at the Uiversity of Louisville; Julie Priest, MSPH, is a programmer aalyst at Iveresk Research i Cary, NC; ad Cathy Fodi, RN, is a primary care urse practitioer at the VA Hospital i Asheville, NC. This research was fuded by the Natioal Cacer Istitute (R01 CA ) ad the South Carolia Cacer Istitute. This article is based o the authors viewpoits ad is ot represetative of the Natioal Cacer Istitute s opiio. (Submitted Jauary Accepted for publicatio July 1, 2002.) Digital Object Idetifier: /03.ONF.E12-E16 E12

2 al., 2002). I the 1992 Natioal Health Iterview Survey, sigificat differeces existed i participatio i screeig that used a digital rectal examiatio (DRE). Lower icome ad Africa America me were least likely to participate. Sigificatly fewer Africa America me (betwee the ages of 40 ad 70) with family icomes of less tha $20,000 had had a DRE i their lifetimes i cotrast to Africa America me with a household icome of $20,000 or more (32% versus 51%, p = 0.05) (M. Brow, persoal commuicatio, February 18, 1997). Disagreemet exists about the effectiveess of prostate cacer screeig, i terms of lives saved, amog experts who both support ad oppose prostate cacer screeig (Etzioi et al., 1999; Feuer, Merrill, & Hakey, 1999; Johasso, Holmberg, Johasso, Bergstrom, & Adami, 1997; Labrie, 2000; Mettli, 2000; Weirich, 2001). Agecies that support screeig advocate iformed decisio makig, i which the me are educated regardig the beefits ad limitatios of prostate cacer screeig (Smith et al., 2001; Weirich). Priority groups for prostate cacer educatio ad research eed to be at-risk populatios, which iclude Africa America (Eyre & Feldma, 1998; Myers, 1999) ad low-icome me (Weirich, Elliso, et al., 2000; Weirich, Weirich, et al., 2000). Icreased participatio i prostate cacer screeig has bee reported whe the barriers of cost ad lack of kowledge are removed (Abbott, Taylor, & Barber, 1998; Demark- Wahefried et al., 1995; Myers et al., 2000; Powell, Gelfad, Parzuchowski, Heilbru, & Frakli, 1995; Powell et al., 1997; Weirich, Weirich, Boyd, & Mettli, 1998). Me most likely to participate i prostate cacer screeig are those who have higher educatio, favorable views of early detectio, ad strog physicia support for early detectio (Myers et al.). Ufortuately, decreased participatio amog Africa America ad low-icome me has bee documeted (Weirich, Reyolds, et al., 2000; Weirich, Weirich, Boyd, & Atkiso, 1998; Weirich, Weirich, Atwood, & Cobb, 1999). No published studies are available that examie reasos for the failure to participate i prostate cacer screeig whe the barriers of cost ad educatio are removed for lowicome ad Africa America me, two groups at highest risk for prostate cacer mortality. Previous published research o the South Carolia Prostate Cacer Study has documeted some barriers, icludig embarrassmet, lack of trasportatio, procrastiatio, icoveiet hours for physicias, ad lack of kowledge of where to go for medical assistace (Shelto & Weirich, 1999; Weirich, Reyolds, Tige, & Starr, 2000). Three research questios were formulated based o the literature. What were the self-reported reasos for failure to participate i a free prostate cacer screeig? What is the associatio betwee the self-reported reasos for failure to participate ad demographic variables? What predicts subsequet participatio i prostate cacer screeig? Methods Desig ad Study Sample This descriptive, correlatioal study, which recruited subjects i three stages, was a secodary aalyses from a larger study (Weirich, Weirich, Boyd, & Mettli, 1998). The sample icluded me who did ot participate i a free prostate cacer screeig followig a educatioal program, were cotacted by telephoe to elicit self-reported reasos for ot participatig, ad were give a secod opportuity for a free screeig. I the first stage of the larger study, coducted betwee 1995 ad 1996, 1,901 me at 222 differet commuity sites completed a survey, participated i a educatioal program o prostate cacer, ad were offered free prostate cacer screeig from their physicias of choice (Weirich, Weirich, Boyd, & Mettli, 1998). The educatioal program icluded iformatio o sigs ad symptoms of prostate cacer, the America Cacer Society s prostate cacer screeig guidelies, ad beefits ad limitatios of prostate cacer screeig (Weirich, Weirich, Boyd, & Mettli). A total of 1,060 (56%) me wet to their physicias of choice for the free prostate cacer screeig. The physicias billed those who were coductig the research study for the cost of the screeig. Africa America ad low-icome me were the least likely to have participated i the first phase of the larger study (Weirich, Weirich, et al., 2000). No record of screeig was obtaied from the remaiig 841 me. Follow-up calls to a radom list of 275 of the 841 me revealed that 18% of the me had goe to their idividual physicia of choice, but the physicias had ot billed the research study for the cost. I the secod stage of this study, coducted i 1997, the remaiig 566 me were called ad asked why they had ot participated. Of the 566 me, 153 me (27%) could ot be reached after repeated calls. Of the 566 me, 105 me (19%) reported that they had obtaied the prostate cacer screeig. Calls to their physicias revealed that 102 of them had ideed bee screeed, although their physicia had ot billed the research study. The physicias for the remaiig me ( = 3) foud o record of prostate cacer screeig. Six of the 566 me did ot kow whether they had goe for a prostate cacer screeig examiatio. Durig the secod stage, the 241 me who stated that they had ot yet had a prostate cacer screeig examiatio were set aother voucher to use at their physicia of choice. Stadardized telephoe procedures, which icluded a script ad key areas to discuss, were developed ad followed for stages 2 ad 3. I the third stage of this study coducted i 1997, 302 (53%) me out of the 566 me who were reached by telephoe were give a secod opportuity for a free screeig with their idividual physicia of choice. Amog the 302 me, 241 me gave at least oe reaso for ot acceptig their first free screeig opportuity ad were icluded i this research study. This article reports o reasos for ot participatig give by these 241 me. Istrumet The researcher for the telephoe survey i stage 2 developed a ope-eded questio to obtai data o reasos me did ot participate i the first offer for free prostate cacer screeig. It was developed by S. Weirich, the author, who is a expert i prostate cacer educatio ad screeig amog Africa America ad low-icome me (Trossma, 2000; Weirich, Boyd, & Powe, 1997). The questio was pilot tested with 15 me. Mior chages i wordig were made to improve readability ad adapt it to a eighth-grade readig level. Reasos give by some me were cited as part of the WEINRICH VOL 30, NO 1, 2003 E13

3 telephoe iterview. The fial wordig of the questio was Several me have told us why they chose ot to go for a prostate checkup. Some me did ot go because they did ot have time, some me had problems with their doctor, ad some me did ot wat to have the digital rectal exam. Ca you tell us why you decided to ot have a prostate checkup? Data Aalyses Aalyses for this secodary study was performed usig data from stages 2 ad 3. The reasos me gave i stage 2 for ot goig for the first screeig opportuity were recorded ad categorized ito seve categories: (a) time problems, (b) lost the voucher for the first offer of free screeig, (c) physicia problems, (d) forgot, (e) iteded to go, (f) persoal problems, ad (g) a variety of other idividual reasos. Descriptive statistics were performed usig SAS versio 6.12 software to examie self-reported reasos for failure to participate i a free prostate cacer screeig. Chi-square tests of sigificace, Fisher s exact test, uivariate tests, ad multiple logistic regressio were used to test the self-reported reasos for failure to participate, ad demographic variables predicted subsequet participatio based o self-reported reasos. Results Demographics The 241 me from stages 2 ad 3 raged i age from years ( X = 50 years; SD = 7.4). Most of the me were Africa America (79%) ad married (70%). Whe educatio was codesed ito three categories (less tha high school, some high school or graduated from high school, ad more tha high school), 57% of the sample had atteded or graduated from high school. More tha half of the subjects (62%) had low icomes, defied i this study as a family icome of less tha $,020 per year. Statistically sigificat differeces existed by race i the distributios of icome ad age categories (p < 0.001). The distributio of demographic variables, icludig age, race, educatio, icome, ad marital status, is summarized i Table 1. Table 1. Descriptio of Sample Demographics Age* (years) Educatio Less tha high school (HS) Some HS/HS graduate More tha HS Icome* $9,600 or less $9,601 $,020 $,021 or more Marital status Married Sigle, widowed, divorced, or separated N = 241 *p = Africa America Me (N = 190) Self-Reported Reasos Me Did Not Participate There were differet reasos give by the me i stage 2 of the study for ot acceptig the first offer of free prostate cacer screeig. The most frequet reaso give for ot goig for the first screeig opportuity was time problems (46%). The remaiig reasos icluded lost the packet (17%), physicia problems (16%), forgot (11%), iteded to go (6%), ad persoal reasos (6%) (see Table 2). A variety category icluded idividual reasos such as do ot like exam, do ot eed it, expressed fear, procrastiatio, apathy, did ot kow to go, ad other reasos ( = 65). The percetages sum to more tha 100% because may me (57) gave more tha oe reaso for ot participatig i the first screeig opportuity. Examples of resposes that were coded i the category of time problems ( = 110) were too busy ad did ot take the time to go. Examples of resposes that were coded i the category of physicia problems ( = 39) were eed a ew doctor, eed to chage doctors, ad doctors refused to accept the free voucher packet or to perform the prostate exam. Specific commets for the forgot category ( = 26) i additio to forgot were could ot remember. Me who had persoal or health problems were listed as persoal problems ( = 14). No sigificat differeces by race were see i the distributio of reasos give for ot participatig. Associatios Betwee Self-Reported Reasos for Failure to Participate ad Demographic Variables A statistically sigificat relatioship was foud betwee the icome variable ad physicia problems for ot participatig i the first screeig. The middle-icome group ($9,601 $,020 per year) was more likely to cite physicia problems as their reaso for ot participatig tha me i the lower-icome (< $9,600 per year) or higher-icome (> $,021 per year) categories (p = 0.03). Physicia problems icluded refusal of physicias to ivoice for paymet or the lack of a physicia. No other statistically sigificat relatioships betwee the demographic variables ad the self-reported reasos for failure to participate existed. Race was ot sigificat. Predictors for Acceptace of Secod Opportuity for Free Prostate Cacer Screeig Twety oe percet ( = 51) of the 241 me accepted the secod opportuity for free prostate cacer screeig. No sigificat differeces were see i race durig the secod opportuity for free screeig (22% of Africa America me versus 18% of Caucasia me). Reasos give by the me for ot acceptig the first opportuity for free prostate cacer screeig were examied as predictors for acceptace of the secod opportuity. Predictors, based o the me s self-reported reasos, were time problems, lost the ivoice packet, doctor, forgot, itet, ad persoal reasos. A sigificat differece i participatio i the secod free prostate cacer screeig was foud i the group who said % Caucasia Me (N = 51) % E14

4 Table 2. Self-Reported Reasos for Not Participatig i Free Prostate Cacer Screeig Followig a Educatioal Program Reasos Give Time problem Lost the voucher Physicia problems Forgot Iteded to go Persoal or health problem Other (apathy, procrastiatio, do ot like exam) a Percets total more tha 100% because some subjects listed more tha oe reaso for ot participatig. N = 241 they had lost the voucher packet. More tha oe third (37%) of the 41 me who said they did ot go for the first offer for free screeig because they lost the voucher packet did participate i the secod opportuity for a free screeig. This was statistically sigificat (p = 0.008). These me were more tha twice as likely to go for the secod opportuity of free screeig whe offered aother voucher (OR = 2.62, p = 0.01). No other sigificat predictors were foud. Discussio Limitatios Results ca be geeralized to me i souther commuity settigs who received educatio o prostate cacer screeig. These self-reported reasos caot be geeralized to me who decide ot to be screeed but who have ot received educatio o prostate cacer screeig. The age of the data, which were first collected i 1995 ad 1996, is a limitatio. However, the lack of other studies i the literature o self-reported reasos for failure to participate i prostate cacer screeig followig educatio merit this publicatio. The desig of this secodary aalyses, which collected data from the me two years after they received prostate cacer educatio, is a stregth. Curretly, the aswer for the atioal debate o the efficacy of prostate cacer screeig is for each urse practitioer or physicia to iform ad actively ivolve each ma i the decisio-makig process for or agaist prostate cacer screeig after the beefits ad limitatios are discussed. This is the oly article published o the self-reported reasos, by a cohort of me who received prostate cacer educatio, for failure to participate i free screeig. Similarly, o other published data are available o me who have bee give a secod opportuity for free screeig % a Nursig Implicatios The sigificat relatioship betwee icome ad physicia problems has implicatios for healthcare providers regardig why me decide ot to participate i prostate cacer screeig. Me ofte eed assistace with accessig or makig appoitmets for health care eve whe the cost for the care is free. The assistace ca iclude access to phoe umbers, remiders such as caledars to keep the appoitmets, ad trasportatio. Specifically, the middle-icome group of me was more likely to cite physicia problems as their reaso for ot participatig. I cotrast, the low-icome me were less likely tha the middle-icome me to participate i the free prostate cacer screeig (Weirich, Weirich, et al., 2000). Nurses eed to recogize that me with middle or low icomes may eed assistace with avigatig the healthcare system. The problem of the physicias refusig the ivoice highlights the eed for the payor of the ivoice to itervee directly with the healthcare provider to esure that service is provided. The problem of did ot have a physicia highlights the eed to provide ames, addresses, ad phoe umbers of healthcare providers who accept vouchers. Ideed, the South Carolia Prostate Cacer Study demostrated that whe me are provided assistace usig the Cliet Navigator Method, icreased screeig occurs (Weirich, Weirich, Boyd, & Mettli, 1998). The Cliet Navigator Method cosisted of a urse or social worker who cotacted the me by telephoe, idetified barriers, ad assisted with idividual problems. The method also icluded three remiders: a key rig, caledar, ad refrigerator maget to record a physicias ame ad telephoe umber. The lack of associatio with race with ay of the self-reported reasos is a mystery that eeds additioal research. Africa America me i both this study (Weirich, Weirich, Boyd, & Mettli, 1998) ad atiowide (Mettli et al., 1998) are less likely to participate i prostate cacer screeig i cotrast to Caucasia me. Additioal research usig qualitative methodology is eeded to idetify the reasos. Before the opportuity for free screeig, all of these me had received a prostate cacer educatioal program that discussed differet treatmet optios, icludig watchful waitig. The potetial side effect of sexual dysfuctio from some prostate cacer treatmets was discussed i the questio ad aswer sessio. Of iterest, oe of the me reported potetial icotiece or erectile dysfuctio from treatmet as reasos for ot participatig i the prostate cacer screeig. Aother implicatio for healthcare providers workig with at-risk me is the low participatio with the secod opportuity approximately oe ma i five participated. The predictor for subsequet participatio of losig the voucher has implicatios for healthcare providers. Issuig a ew voucher led to improved participatio. Future programs could beefit from this iformatio by providig telephoe follow-up with the me ad r ig vouchers for me who fail to participate. Also, me could be ecouraged to desigate oe place i their household for health-related papers ad keep their voucher i this place util their appoitmet with the healthcare provider. Healthcare providers eed to explore a more effective maer of paymet for the examiatio. Lost vouchers for reimbursemet were a sigificat reaso that the me did ot participate. Direct commuicatio with the me s physicias of choice is a optio. The healthcare barriers idetified i this research may apply to other populatios. Future research should cotiue to focus o prostate cacer mortality rates for high-risk groups: Africa America (Eyre & Feldma, 1998) ad low-icome me (America Cacer Society, 1990). A qualitative study could further clarify reasos for failure to participate i prostate cacer screeig. Author Cotact: Sally P. Weirich, PhD, RN, FAAN, ca be reached at sally.weirich@louisville.edu, with copy to editor at rose_mary@earthlik.et. WEINRICH VOL 30, NO 1, 2003 E15

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