Prostate cancer screening in the midst of controversy, knowledge, attitudes, beliefs, practices, intentions and personal preferences of Canadian men

grantor: University of TorontoThe controversy surrounding prostate cancer screening has experts divided as to whether population-based screening should be undertaken. However, advocates and opponents agree that men should be fully informed of the risks and benefits so they can participate in deciding about personal involvement in screening. This study's purpose was to procure information that will facilitate development of educational materials and strategies regarding prostate cancer screening. The study combined quantitative and qualitative methods. A population-based telephone survey of 629 Canadian men aged 40 and over provided a representative picture of prostate cancer screening awareness, use, and intentions. One-on-one semi-structured qualitative interviews with 25 men allowed in-depth examination of issues raised by the survey analysis. While digital rectal examination (DRE) usage was high, only 15% of survey respondents ever had a prostate specific antigen (PSA) test, and only 9% ever had a screening PSA. However, intentions to have a future PSA test were greater than use to date both among survey respondents who only had partial information about screening and among interview participants after they were fully informed. Most men had little knowledge and few attitudes and beliefs about prostate cancer screening. Qualitative participants differed regarding how much information they would want and when they would want it. They believed that information sources have to be credible, trustworthy, timely, feasible, and must instill hope. They suggested a man's physician should be the gatekeeper to information dissemination. Quantitative multivariate models revealed predisposing, enabling, and reinforcing variables associated with DRE and PSA awareness, use, and intentions. Some of these variables suggest population subgroups most in need of educational materials and others denote factors that need attention if men are to make informed decisions about screening. Qualitative analyses identified nine themes that distinguished between men who came to different decisions about personal involvement in PSA screening. These themes will help educators, physicians, and others understand how men might take the same information and interpret it differently. This thesis suggests that fully informing men requires a coordinated approach so all players men, physicians, and educators--can take responsibility and participate in a manner that meets their needs.Ph.D