Development of a culturally tailored educational tool designed to increase access to somatic testing among Black men with metastatic prostate cancer (mPCa).

Abstract

1591 Background: Somatic testing (ST), also known as molecular profiling, has become increasingly important for therapy selection in men with mPCa. Interventions targeting known racial inequities in the use of ST are lacking. Our objective was to design a culturally tailored educational tool to augment patient education with the ultimate goal of increasing equitable access to ST for Black patients with mPCa. Methods: We used principles of human-centered design to develop a ST educational tool. We first designed a prototype with key stakeholders, then conducted a qualitative study of Black patients with mPCa at three sites – a tertiary care academic center, a VA medical center, and a safety net oncology clinic. Trained interviewers conducted semi-structured interviews to explore patients’ perceptions of ST and elicit feedback about the educational tool until data saturation was met. Based on this feedback, we iteratively revised the tool. Interviews were transcribed, and two coders qualitatively analyzed transcripts using the COM-B framework to identify barriers/facilitators of tool use. Results: For the initial prototype, four physicians, one genetic counselor, and two patients contributed to the design of a 7-min video of a Black oncologist with informative animations followed by a text-based decision aid. We approached 18 patients, of whom 11 (61%) consented to review the tool then complete the interview. All participants expressed a positive perception of the tool and comprehension of the information. Tool facilitators included 1) trust in the tool, 2) actionability of the tool’s content, and 3) appreciation for a Black physician featured in the video. Barriers included 1) difficulty navigating the electronic interface, 2) negative emotions from reflection on their cancer diagnosis or racial inequities, 3) too much information in the decision aid, particularly about biopsy risks and testing costs, and 4) content concerns on risks associated with ST/biopsy. For participants’ perceptions of ST, facilitators included 1) desire to learn more about mPCa and 2) motivation to improve their health, their family's health, or the health of the Black community. Barriers included 1) misinformation about ST and mPCa, 2) difficulty accessing affordable healthcare, 3) mistrust of the healthcare system due to prior negative experiences, and 4) belief that mPCa and its treatments are emasculating. Overall, 10/11 patients reported planning to either discuss ST with their oncologist (7/11) or obtain ST (5/11). Conclusions: We successfully designed an educational tool for pre-test education about ST for Black men with mPCa. This educational tool was well received and may have contributed to PCa patients further pursuing somatic testing. Further evaluation of the feasibility, acceptability, and efficacy of this educational tool is warranted.