1. PROSPEC
Presented by: Leah Brown
Mentor: John Holmes, PhD &
Annie Chung

2. Background
 What is Prostate Cancer?
 What are the risk factors?
 Age
 Race
 Family History
 How it is detected?
 Prostate Specific Antigen Test (PSA)
 Digital Rectal Exam (DRE)

3. Goals of PROSPEC
 Funded by the NCI
 Created an interactive, computerized
patient-centered intervention
 Facilitate patient and physician
discussion
 Reduce racial disparity that may exist in
screening practices

4. Significance of PROSPEC
 Prostate Cancer Screening (PCS) is
very controversial
 Treatment may reduce the quality of life
 Unclear if treatment reduces mortality
rates

5. How it Relates to me
 Health & Societies major
 Concentration in Bioethics & Society
 I want to be an epidemiologist!

6. Description of PROSPEC
 Over the course of 3 years
 Community Interviews
 18 African-American Males and 14 Caucasian Males
 Ages 40 – 75
 Semi- Structured Interview; asked questions about
health care, opinions of PCS, & computer usage
 Physician Interviews
 17 physicians
 Semi-Structured Interview; asked questions about
barriers regarding having a discussion about PCS
Time Constraints, Physicians forgot to bring PCS
up, & Assumptions made about the educational
level of the patient

7. Description of PROSPEC
 Evidence – Based Ontology
 A formal knowledge model that describes
concepts related to PCS beliefs and
attitudes

8. Description of PROSPEC
Evidence- Based Ontology
COMPUTERIZED INTERVENTION
Community Interviews Physician Interviews

9. Description of PROSPEC
 Created interactive, computerized
patient-centered intervention
 Encourages the patient to:
 Ask questions
 Check Understanding
 Express Thoughts
 Watch a clip of the film!

10. Description of PROSPEC
 100 pre-intervention patients & 62
post-intervention patients
 Following clinical encounters were audio-
taped
 Completed Prostate Cancer
Questionnaires
 Post-intervention completed a specific
questionnaire about the usefulness of the
film

11. My role in PROSPEC
 Analyzed 10 pre-intervention & 10
post-intervention clinical
encounters
 Who initiated Prostate Cancer
Discussion?
 Who mentioned the film?
 What questions did the patient ask?
 What language was used?
 What was the style of communication
between the patient and doctor?

12. Findings
Pre-intervention Post-Intervention
 No knowledge of PCS/  Similar language use to
Confusion with the film
Colonoscopy
 Most often the physician Most often the patient
initiated discussion initiated discussion
 Physician took a Conversational dialogue
Biomedical Approach between patient and
physician

13. Pre-Intervention
 No knowledge of PCS/ Confusion with
Colonoscopy
P: Yeah I took the other one…what do you call
it? It went down to uh…it’s the thing where
they put the tube and they go through….
D: The colonoscopy?
P: Yeah, I had that. It was interesting.
Everybody says that…I stayed awake the
whole thing.

14. Pre-Intervention
 Physician took a biomedical approach
D: I was going to do that blood test.
P: Oh, ok. I do? Oh, prostate too.
D: Yeah.
P: So we’re gonna do it next visit.
D: Yeah. Okay?

15. Post-Intervention
 Similar language use
Film Language: "That's what I'm worried
about...." "I am more concerned now..."
P: I don’t know how other people feel but I’m
a worry wart when it comes to prostrate
[sic] cancer. And I was telling them that I
was always under the impression when I
started coming to you….”

16. Post-Intervention
 Similar language use
Film Language: “Can you tell me more about
it?”
P: I wanted to ask you more about that.
D: Prostate cancer…screening for prostate
cancer. Well, prostate cancer is an
interesting thing.

17. Post-Intervention
 Conversational Dialogue between the patient
and physician
P: This thing that I just did with the two young ladies. Pretty informative.
D: Mm-hmm.
P: I don’t know how other people feel but I’m a worry wart when it comes
to prostrate [sic] cancer. And I was telling them that I was always
under the impression when I started coming to you, you gave me the
PSC [sic] test. Well, the film that I just watched…
D: Yeah
P: I should be getting a rectal exam too because according to that film, that
PSC [sic] could be missing. I could have a lump on my prostrate [sic]
or something.
D: Yeah, the thing about it that complicates that is sometimes doing the
prostate exam can somewhat elevate your PSA when we get it. But we
can definitely do an exam…it’s mostly…

18. Findings
 Who initiated PCS Doctor Patient
discussion? Initiated Initiated
 Self-reported on Pre- 76.8% 23.2%
interven
the questionnaire tion
 There was a patients
statistically Post- 31.6% 68.4%
Interven
significant result! tion
patients

19. What I learned
 Research is very tedious, but
rewarding!
 Develop a strong mentorship
 What makes a good epidemiologist?
 Inquisitive
 Self-directed
 Stats! Stats! Stats!
 Use of software programs like Nvivo
&R

20. Future Plans
 Continuing to use the PROSPEC data
in the fall with an independent study
 Research question, “How are Black
men discussing health conditions with
their doctors?”
 What is the influence of spouses on
patient/physician communication and
medical decision making?

21. Thanks!
 Joanne Levy and the entire LDI staff
 John Holmes, PhD
 Annie Chung
 Fellow SUMR Scholars
 My family back in Virginia Beach

22. References
 American Cancer Society