Knowledge, Attitudes and Beliefs of Women about the Importance of Prostate Cancer Screening Kristi Blanchard; Tracy Proverbs-Singh; Adrienne Katner; Deborah Lifsey; Steven Pollard; and Walter Rayford, MD, PhD, FACS New Orleans, Louisiana Objectives: To understand women's knowledge, attitudes and beliefs about prostate cancer. Methods: A survey was self-administered to 324 women age >18 years. It contained 42 questions that assessed women's knowledge about prostate cancer, possible risk factors, and opinion! regarding screening and early detection. Women were grouped as marnied or unmamed for convenient comporisons. Chi-squared and F statistics were performed. Results: Ninety-seven percent of marred women reported having some influence over the healthcare decisions of their spouse. Married women's worst fear about their spouse or family member's diognosis of prostate cancer was death. The most important benefit of prostate cancer screening was the possibility of cure, while the main hindrance was fear of the digital rectal exam. Marital status, age, educational level and income were all significantly associated with women's knowledge about prostate cancer (pO.OO1). Conclusions: Women play an important role in health-related matters in the home. Educating women on prostate cancer may improve early detection efforts and reduce the devastating impact of this disease on their family. Key words: African-American women U KAB (knowledge, attitudes and beliefs) * prostate cancer a screening
© 2005. From the Department of Urology, Louisiana State University Health Sciences Center, Stanley S. Scott Cancer Center, New Orleans, LA. Send correspondence and reprint requests for J NatI Med Assoc. 2005;97:1378-1385 to: Walter Rayford, MD, PhD, FACS, Louisiana State University Health Sciences Center, Department of Urology, Stanley S. Scott Cancer Center, New Orleans, LA 70112; phone: (504) 568-3586; fax: (504) 568-4849; e-mail:
[email protected]
1378 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
INTRODUCTION Prostate cancer is the most frequently diagnosed noncutaneous cancer in American men and the second leading cause of cancer-related deaths in the United States.'"2 The diagnosis of clinically localized prostate cancer is associated with a 95% survival rate compared to 30% if the diagnosis is made after metastasis.3 African-American men have a 66% greater risk of being diagnosed with prostate cancer and the highest mortality rate in the world, which is twice that of Caucasian men. -6 Thus, detecting prostate cancer in the early stages of disease while there are several treatment options from which to select and better chances for cure is crucially important for all men, particularly African-American men. Several factors are associated with a greater likelihood of a man being screened for prostate cancer: race (Caucasian-American men), age decade (60-70 years) and socioeconomic factors.7-9 Additionally, it has been shown that men who perceive the benefit of prostate cancer screening and realize the advantages of early detection are screened more frequently.8 Knowledge about cancer and cancer screening tests,7 physician influence'0 and family influence" have all been shown to play a role in participation in cancer screening programs. The challenge of identifying new methods to target high-risk populations is essential and should include searching for new mechanisms to educate men on the benefits of annual screening. Women are the primary healthcare providers in many American households. Thus, they have the potential to impact household and family members' health-seeking behaviors. Marital status has been a well-documented predictive factor for women with regard to cervical and breast cancer screening.'2"13 This has recently been demonstrated to be true ofmen concerning prostate cancer screening.3"4 Furthermore, men acknowledge seeking out their wives as one of their sources of health information.' In this study, we sought to assess women's knowledge, attitudes and beliefs about prostate cancer to further assist our VOL. 97, NO. 10, OCTOBER 2005
IMPORTANCE OF PROSTATE CANCER SCREENING
efforts in educating men about the importance of screening and early detection. Additionally, the study was targeted to predominantly African-American women in order to gain a better understanding oftheir perceived role in the health-seeking behavior of their spouses and male family members.
METHODS A self-administered survey that contained 42 questions and assessed women's general knowledge about prostate cancer, possible risk factors and per-
sonal opinions regarding the disease and screening was administered to 324 English-speaking women (by convenience sampling) age >18. This multiplechoice formatted questionnaire was designed to require less than half an hour for completion in order to avoid unduly taxing respondents, and in practice it required an average of 20 minutes to complete. The questionnaire was at a junior-high-school reading proficiency. Response rates for completion exceeded 90%. The questionnaire was developed by an interdisciplinary team, incorporating feedback
Table 1. Demographics n (%)
Mean Knowledge Score (95% Cl)
P Value
Race/Ethnicity Caucasian/white African-American/black Hispanic/white Hispanic/black Other Refused to answer
4 (1.2) 278 (85.8) 2 (.6) 7 (2.2) 9 (2.8) 24 (7.4)
Age 18-30 31-40 41-50 51-60 61-70 70+ Refused to answer
36 (11.1) 57 (17.6) 81 (25.0) 58 (17.9) 50 (15.4) 16 (4.9) 26 (8.0)
6.31 (4.88, 7.73) 7.95 (7.01, 8.89) 7.25 (6.61, 7.89) 7.69 (6.86, 8.52) 6.1 (5.06, 7.14) 6.5 (4.62, 8.38)
0.036a
Marital Status Married Living with significant other Single Widowed Divorced/separated Refused to answer
120 (37.0) 14 (4.3) 69 (21.3) 33 (10.2) 62 (19.1) 26 (8.0)
7.68 6.86 6.39 6.09 7.34 7.68
(7.05, (5.20, (5.63, (5.05, (6.37, (7.05,
8.31) 8.52) 7.15) 7.13) 8.31) 8.31)
0.047b
Education Grade school Some high school High school Some college College Other Refused to answer
6 (1.9) 19 (5.9) 67 (20.7) 95 (29.3) 101 (31.2) 7 (2.2) 29 (9.0)
4.17 (1.32, 7.02) 5.21 (3.36, 7.06) 6.04 (5.31, 6.78) 7.22 (6.50, 7.94) 8.18 (7.53, 8.83) 8.57 (6.98, 10.16)
