Prostate REACH, Navigating Men to Prostate Health

Background: The Prostate Risk Assessment Program (PRAP) at Fox Chase Cancer Center is a longitudinal screening and research program that provides screening and risk-reducing options to men at high risk for prostate cancer (PCa). Prostate REACH (Risk, Education, and Assessment in the Community with Help) was developed to increase PRAP access by African American men, who have the highest risk compared with other races, but who experience barriers to participation. Key features of prostate REACH include community screening using a mobile van, a small pool of subsidy funds, and a patient navigator (PN) to provide assistance with recruitment and enrollment issues. Prior studies have shown that African American men tend to distrust medical programs not provided by African American physicians but may be more willing to participate if contact is maintained with a community outreach worker.

Objective: Increase participation in PRAP by a diverse group of African American men.

Methods: The PN engaged partner churches and an African American–oriented radio station as screening sites. She supplemented PRAP recruitment efforts with REACH radio ads and flyers disseminated at churches. Interested men called the PRAP office and if eligible were scheduled for an appointment. Uninsured men were referred to Patient Financial Services and asked if contact by the PN was acceptable. Upon consent, contact information was forwarded to the PN, who called each man to assist with insurance and/or other issues related to enrollment. As needed, she maintained contact through the entire process from enrollment through screening and follow-up. PN interactions were captured in an Excel spreadsheet. The PN attended every screening event, at which she obtained written consent and administered a satisfaction survey.

Results: Prostate REACH prompted 53 phone calls, and 49 men scheduled appointments. Of those, 25 came for screening over 13 screening dates. Nine men had abnormal screenings resulting in 2 biopsies and 1 diagnosed case. Seventy-five percent of men used navigation and were contacted on average twice by the PN. The most common barrier to participation was lack of insurance (83%). Men with abnormal findings required more extensive navigation including help with obtaining public insurance and free medications. In 1 case, the PN was instrumental in getting VA benefits reinstated so surgery could be covered. Over 75% of men found the community setting important in their decision to be screened, and 69% were extremely satisfied with navigation services.

Conclusions: Black men are at high risk for developing prostate cancer, and new strategies are needed to increase awareness, informed decision making, and possible participation in screening as well as research. One strategy is to bring PCa risk assessment programs directly into high-risk communities. However, implementing such programs is not easy and presents a range of challenges. Navigation services appear to be key to making this effort work.