Barriers and Facilitators of Shared Decision Making in Prostate Cancer Treatment Among African American Men

Background: African American men face significant disparities in prostate cancer outcomes, influenced by low trust in health care providers and disparities in treatment quality. Shared decision making (SDM) is recommended to improve engagement and outcomes within this population. Methods: Semistructured interviews were conducted with 15 African American men diagnosed with early-stage prostate cancer within the Veterans Administration health system in Louisiana. The Theoretical Domains Framework guided the interview guide development and qualitative data analysis. Results: Participants had a mean age of 68.8 years; 53% held a high school diploma or GED, and 40% had higher education. Employment statuses included 27% retired and 53% employed part-time. Self-reported physical health was rated as "poor/fair" by 47% and mental health by 53%. We found that 46.67% believed health care organizations cover up mistakes, and 40% felt deceived or misled. Despite these concerns, 73.33% disagreed that mistakes are common. Regarding physician trust, 86.67% felt their doctor cared about them, but 66.67% believed their care was not comprehensive. However, 80% trusted their doctor's judgments, and 66.67% followed their doctor's advice. Participants highlighted gaps in prostate cancer awareness and varied prediagnosis health management practices. Social support varied; some relied heavily on family, while others preferred independence. Trust in health care providers was generally high despite past negative experiences and high physician turnover. The SDM process was valued, needing clearer communication about treatment options and side effects. Conclusions: While African American veterans generally trusted their physicians and valued the SDM process, significant mistrust toward health care organizations, concerns about comprehensive care, and gaps in prostate cancer awareness and health management practices highlight the need for improved communication and support.