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Ethnographic investigation of patient–provider communication among African American men newly diagnosed with prostate cancer: a study protocol
  1. Nynikka R Palmer1,2,3,
  2. Janet K Shim4,
  3. Celia P Kaplan3,5,
  4. Dean Schillinger1,2,
  5. Sarah D Blaschko6,
  6. Benjamin N Breyer7,8,
  7. Rena J Pasick3,5
  1. 1Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
  3. 3Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
  4. 4Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California, USA
  5. 5Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  6. 6Division of Urology, Highland Hospital, Oakland, California, USA
  7. 7Department of Urology, University of California San Francisco, San Francisco, California, USA
  8. 8Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Nynikka R Palmer; nynikka.palmer{at}ucsf.edu

Abstract

Introduction In the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient–provider communication contributes to suboptimal care, which can be exacerbated by patients’ limited health literacy, providers’ lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making.

Methods and analysis Using an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients’ understanding of their diagnoses and treatment options, sources of support in decision-making, patient–provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients’ experiences and providers’ perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data.

Ethics and dissemination To our knowledge, this is the first study to examine in-depth patient–provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.

  • oncology
  • quality in health care
  • protocols & guidelines
  • urological tumours
  • public health
  • qualitative research
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @PalmerNynikka

  • Contributors NRP is the overall project leader and the grant holder with responsibility for the design and execution of the protocol. All authors contributed to the initial conception, the design of the study and the development and refinement of the protocol. NRP led the development of the initial study protocol, which RJP, CPK, DS, JKS, BNB and SDB reviewed and provided feedback. NRP led the development of instruments, interview guides and schedule for data collection, with input from all coauthors. RJP, BNB and JKS provided expertise on recruitment and data collection processes and systems for collecting data from medical records. NRP drafted this manuscript and all coauthors provided critical feedback. All authors read and approved the final version of the manuscript.

  • Funding This work was supported by the National Institute on Aging of the National Institutes of Health under grant number P30AG015272 (University of California San Francisco, Center for Aging in Diverse Communities); the National Center for Advancing Translational Sciences of the National Institutes of Health under grant number KL2TR001870; and the National Cancer Institute of the National Institutes of Health under grant number K01CA211965.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the University of California San Francisco Institutional Review Board (16-20126) and the Alameda Health System Institutional Review Board (IRB17-03311A). Written informed consent is obtained from all patient participants. Verbal consent is obtained from all providers of enrolled patients, as written consent was waived by the University of California San Francisco Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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