Factors associated with knowledge, confidence, self-efficacy, and satisfaction in African American men's decisions about prostate cancer screening.

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Abstract
African American men (AAM) have persistently had the highest incidence and mortality rates for prostate cancer (PrCa) in the United States. Considering that current guidelines recommend the practice of shared decision-making to determine whether or not to undergo a Prostate-Specific Antigen (PSA) test for the early detection of PrCa, this study focuses on the identification of key factors influencing AAM decisions regarding having or not having PSA screenings. Cross-sectional study of 152 AAM who completed study surveys. Statistical analysis included frequencies, means, and distributions and methods to test for differences in knowledge confidence, satisfaction and, self-efficacy when making decisions. 94% of participants would get a PSA test if offered, only 57% knew that the PSA test is a blood test. Participants who reported having had a PSA test before the baseline had significantly higher mean scores than their counterparts in the knowledge about the definition of the PSA and biopsy exams (p = 0.04), and in the confidence (p = 0.005) and efficacy (p = 0.002) scales when making PSA screening decisions. Older participants were more likely to have had a PSA test (p < 0.0001) and to intend to screen (p = 0.0441). Significant differences in the satisfaction scale by clinical site (p < 0.001) may underscore the influence of clinicians' practices in participants' satisfaction with their decisions. Results suggest that patients' experience of care has the potential to positively influence PSA screening. It is our call that type of health insurance, knowledge about PrCa and PSA, and having had a PSA test in the past, as well as the patient's characteristics (age, race and family history of PrCa) be considered when discussing with patients the harms/benefits of PSA screening and their preferences to have or not have the PSA test.

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