MP28-03: Evaluating an Informed/Shared Decision-Making Program for Prostate Cancer Screening among Members of the World Trade Center Health Program: Results from an Implementation Study

Michael Diefenbach*, Thomas Mistretta, Manhassett, NY, Simon Hall, Manish Vira, New Hyde Park, NY, Allison Marzilliano, Manhassett, NY, Andrea Yacoub, Manhasset, NY, Mayer Bellehsen, Manhassett, NY, Jason Kornrich, New Hyde Park, NY, Jacqueline Moline, Manhasset, NY

Introduction: After 20 years of the World Trade Center (WTC) attacks, first-responders suffer from physical and psychological comorbidities at a higher rate than the general population.  They also have been found to be at an increased risk for developing prostate cancer; yet, prostate cancer screening is not part of the annual monitoring visit offered by the WTC Health Program (WTCHP).

Objective: To develop and evaluate a stepped informed/shared decision-making program for prostate cancer screening decisions for this vulnerable population that can easily be integrated into the WTCHP.

Methods: Prior to their annual monitoring visit, members of the WTCHP received a brochure detailing the pros and cons of screening, specifically tailored to their needs.  At the beginning of the clinic visit, patients indicated their screening decision (Y/N) or whether they wanted to discuss the screening option further with the provider.  Data were assessed at baseline (i.e., at the time of the screening decision), 3-4 days and three months post-baseline. Questionnaires assessed demographics, general mood, PC screening uptake, general and prostate cancer-specific anxiety and depression, decision satisfaction and regret and program satisfaction.

Results: From a pool of 2546 members of the WTCHP N=666 were eligible and enrolled in our study.  Patients were on average 55.21 years old (SD=7.66). Over 30% or participants were non-White.  Men were uniformly interested in screening, with an uptake of 97.4%, without further physician consultation.  Screening let to a small number of follow-up biopsies and to 5 discovered early-stage prostate cancers (0.20% of all screened (n=2480).  At 3-4 days and at 3-month post screening, men reported high levels of decision satisfaction, no decisional regret or elevated levels of prostate cancer-related anxiety or depression. Providers rated the program highly.

Conclusions: Patient interest in prostate cancer screening was high.  The program integrated well into the clinic and with the help of the screening brochure facilitated patient screening decision making.  There were no short or long-term psychosocial consequences of being screened.

Source of Funding: Centers for Disease Control and Prevention (U01OH01169)