Abstract 4183: Employment status moderates the relationship between patient-provider communication and prostate cancer screening among Black men
Authors: Carter Brian J. , Chen Tzuan A. , Cho Dalnim , McNeill Lorna H. , Reitzel Lorraine R. 
Published: April 2023

Purpose: Black men have 76% higher prostate cancer incidence rate than White men, and 120% higher mortality rate. They are also less likely to be screened via prostate-specific antigen (PSA) testing. Potential harms of PSA testing include overdiagnosis and overtreatment, but recent research suggests that the harm-benefit trade-off may be uniquely favorable for Black men. Increasing Black men’s PSA testing rates may therefore reduce prostate cancer disparities. Studies suggest that employment status and accompanying roles (e.g., family breadwinner or workplace leader) are often central to masculine identity and that employed men may thus anticipate prostate cancer diagnosis and work-disruptive treatment threatening their identity, engendering screening avoidance. Patient-provider communication (PPC), if ideal, may help to reframe PSA testing and overcome barriers unique to employed men. The current work explored this possibility.

Methods: A convenience sample of 246 Black men aged ≥45 (Mage = 56.94±7.88) was recruited from Houston, TX. Self-reported data included satisfaction with PPC (Consumer Assessment of Healthcare Providers and Systems; ideal vs not ideal), current employment status (employed for wages or self-employed vs none), and receipt of PSA test in the past 2 years (yes vs no). A logistic regression model examining the association between PPC and PSA testing assessed moderation using an interaction term, controlling for sociodemographic variables (e.g., age, income, insurance status), family/personal cancer history, cancer risk perceptions, spirituality, and social support.

Results: Overall, 67% of respondents were employed, 39% endorsed ideal PPC, and 73% had a PSA test in the past 2 years. Employed men comprised 68% of those screened. Moderation was significant; employed men reporting nonideal PPC were less likely to have had a PSA test than employed men reporting ideal PPC (OR: 0.262, CI95% = 0.097-0.708). For unemployed men, there was no significant association between PPC and having had a PSA test in the past 2 years.

Conclusion: Ideal PPC may be important to effectively mitigate unique employment-related patient concerns and spur PSA testing for employed Black men. Ideal PPC may be developed by providers building trust with patients, asking them about concerns, verifying their understanding, and engaging them in shared decision-making that respects their values. Employee wellness programs, health insurance companies, cancer centers, cancer survivors, church leaders, and health ministries can work to improve PPC by encouraging patients to have open discussions about prostate cancer with their providers by sharing concerns and asking questions. PSA testing may be cost-prohibitive for unemployed men regardless of PPC; more work is needed to reach this group.

Citation Format: Brian J. Carter, Tzuan A. Chen, Dalnim Cho, Lorna H. McNeill, Lorraine R. Reitzel. Employment status moderates the relationship between patient-provider communication and prostate cancer screening among Black men. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4183.