Ethnic differences in patients' preferences for prostate cancer investigation: a vignette-based survey in primary care

Background Minority ethnic groups in the UK have worse outcomes for some cancer types compared with the white majority. Black males have worse staging at diagnosis of prostate cancer and often present as emergencies, suggesting possible delays in the diagnostic pathway. Delay may arise from lower awareness of cancer symptoms, reluctance to report symptoms, reduced desire for investigation, or a combination of these. Reduced desire for investigation was examined in this study Aim To investigate whether black males in the UK would choose to be tested for prostate cancer compared with the white majority. Design and setting A vignette (hypothetical scenario)-based, electronic survey of male patients aged >= 40 years from four general practices in Bristol, UK. Method The vignettes described possible prostate cancer symptoms (equating to risk levels of 2%, 5%, and 10%), investigative procedures, and possible outcomes. Participants indicated whether they would choose investigation in these scenarios. Analysis used logistic regression, with preference for investigation as the outcome variable and ethnicity as the main explanatory variable. Results In total, 449 (81%) of 555 participants opted for investigation, regardless of risk levels; of these, the acceptance rate was 94% (251 out of 267) among white males and 70% (198 out of 285) among black males. In multivariable analyses, preference for investigation was lower in black males, even after controlling for relevant confounding factors including specific risk level (odds ratio 0.13; 95% confidence interval = 0.07 to 0.25; P<0.001). Conclusion Black males are less likely to opt for investigation at any risk level of prostate cancer compared with white males. This may explain some of their latestage presentation at diagnosis and subsequent poorer outcomes.