Nursing Clinical Problem and Picot Question

Nursing Clinical Problem and Picot Question

Student Name: Angela Overton

Date:

Instructions

Copy and paste this page into a word processor program. In four pages respond to the following questions (be thorough in your responses). You must use this form. Any assignments not submitted on this form will be issued a 10 point penalty. Place your responses in bold type. Place reference list at end of assignment in APA format. Submit your paper to this assignment page by the due date in the calendar.

State the population (P) [10 points; 5 points each]:

Define the population.

African American or Black Americans account for 14% of the population, according to the 2020 U.S. census. They are the third largest ethnic group in the U.S. and consist of recent immigrants of African descent, Caribbean Americans, and African Americans who were descendants of enslaved people brought to the U.S. (Giaquinto et al. 2022). According to the Centers for Disease Control (CDC), African Americans have the “highest death rate and the lowest survival rate of any racial or ethnic group for most cancers.” In the U.S., African Americanmales possessa significantly greater rate of prostate cancer deaths among all racial or ethnic groups (Giaquinto et al., 2022).

Is this clinical nursing problem a priority issue for the patient population? Yes or No? Explain.

Yes. Prioritizing earlier detection and treatment plans of prostate cancer in black men is necessary to lessenits impact on this population. “African American men have a higher incidence of prostate cancer, higher prostate cancer mortality, and are diagnosed with prostate cancer at a younger age than Caucasian American men” (Hinata & Fujisawa, 2022). Black ancestry raises the likelihood of prostate cancer, both in terms of acquiring the disease and succumbing to it, according to the CDC. Research has shown that black men have faster-growing, more aggressive prostate cancers. Given these disparities, there should be tailored screening guidelines for black men.The development and progression of prostate cancer is the determining differencein black men compared to other ethnicities.

State the intervention or issue (I) [10 points; 5 points each]:

Define and explain the intervention or issue.

Routine prostate cancer screening includes a Prostate-Specific Antigen (PSA) blood test.PSA testing is regarded as the gold standard for diagnosing prostate cancer in its early stages (Blum, 2023). There remains an ongoing controversy on when men should be screened for prostate cancer. The CDC recommendations are as follows: the average age for screening begins at 50 years old, 45 years old for A.A. men and those who have at least one first-degree relative, father or brother, with prostate cancer, and 40 years old for very high risk, more than one first degree relative with prostate cancer. In 2018, The U.S. Preventive Service Task Force (USPSTF)recommended PSA testing starting at 55-69 years of age.Although testing increased slightly,informed decision-making remained underutilized at 31% among Black men (Siegel et al. 2024).

How prevalent is the issue/problem? Explain.

Research has indicated that PSA testing in Black men should be three to nine years earlier and more often due to the aggressive nature of the disease within this population (Carroll, 2017). Furthermore, compared to other groups, Black men with lower-grade (less aggressive) prostate cancer have a higher mortality rate from the disease (American Cancer Society Cancer Action Network, 2023). Early detection of Pca might be the key todecreasing the mortality rate in the black community.

What is the setting for this issue/problem [5 points]?

Prostate screening occurs within a healthcare setting. Usually, the appointment starts with a general practitioner who may be performing an annual physical.The patient’s history is gathered, asking if any close relatives, such as the father or brother, had prostate cancer. An assessment of the patient’s knowledge of prostate cancer should be done, and thorough education should be given, ensuring the patient understands the risks and benefits of prostate screening. This understanding is imperative for effective decision-making (Ogunsanya et al.). If the PSA test results are elevated, a consultation is given to see a urologist, where further testing is done. This includes a repeat PSA test that is more in-depth, along with a digital rectal exam to feel any abnormalities of the prostate.

How urgent is this problem or issue (has it been researched in the past 3 years) [5 points]? Yes or No. Validate your response.

The urgency for Black men to get prostate screening sooner allows earlier diagnosis and better treatment options as well as outcomes. According to the American Cancer Society (ACS), there is ongoing research worldwideto determine“the causes, prevention, detection, testing, and treatment of prostate cancer.” There is a continuous attempt to revitalize useful prostate cancer screening(Siegel et al. 2024).The ACS is working to improve the PSA test, as it is not perfect, allowing some cancers to be missed. They have also developed newer, moreaccurate tests that are possibly more reliable than the PSA test.

How many total studies did you identify relative to your issue/problem [10 points]?Identify two significant studies in APA format and state why chosen.

CINAHL database: African American men or black men AND prostate cancer screening or PSA testing. Limiters: Full text, peer-reviewed, years 2014-2024, English language, USA-geography, and subjects-prostatic neoplasms, cancer screening, early detection of cancer, prostate, prostate-specific antigen. There were 44 research articles.

Significant study #1 in APA format with rationale:

Allen, J. D., Reich, A., Cuevas, A. G., & Ladin, K. (2020). Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid. JMIR mHealth and uHealth, 8(5), e15502. https://doi.org/10.2196/15502

Rationale: This study is valuable because it presents PCSPrep, an interactive web-centered decision guide created to help African American males make knowledgeable decisions about prostate cancer screening. The study tackles the requirement for customized treatments to improve comprehension and awareness in this community by leveraging technology, especially an online application.

Significant study #2 in APA format with rationale:

Allen, J. D., Filson, C. P., & Berry, D. L. (2020). Effect of a Prostate Cancer Screening Decision Aid for African-American Men in Primary Care Settings. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 29(11), 2157–2164. https://doi.org/10.1158/1055-9965.EPI-20-0454

Rationale: The purpose of this study is to determine how a web-based decision aid (DA) affects African-American males’ shared decision-making (SDM) regarding prostate cancer screening in the context of primary care. The study employs a pre/post-assessment methodology and focuses on men between 45 and 70. The project aims to increase knowledgeable decision-making and patient-provider participation in talks about prostate cancer screening by addressing the critical need for efficient tools to assist with decisions in medical centers, considering the heightened likelihood of prostate cancer among African-American males.

Complete the following in order to identify the trend in research for your topic. Research identified in the table must represent a 5 to 10 year span of time. List all years separately.

Identify Trend in Research
Study year
Number of studies identified
Journals
Concepts included in studies
2024

Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision Making

Aging, decision making / ethics, primary health care, prostatic neoplasms / epidemiology

2023

Shared decision making in prostate cancer screening: An update
Prostate-specific antigen testing: Evolving evidence and shared decision making

Shared decision-making, prostate cancer screening.
Prostate cancer screening; Prostate specific antigen (PSA) test.

2022

Fostering shared decision-making about prostate cancer screening among African American men patients and their primary care providers: a randomized behavioral clinical trial
Physician Attitudes and Self-reported Practices Toward Prostate Cancer Screening in Black and White Men

African American men; Decision aid; PSA screening; Primary care providers; Prostate cancer; Randomized controlled trial; Shared decision-making.
Shared decision-making, prostate cancer screening.

2021

Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers
Clinical Trial Protocol for a Randomized Trial of Community Health Worker-led Decision Coaching to Promote Shared Decision-making on Prostate Cancer Screening Among Black Male Patients and Their Providers

Community health worker; PSA; Prostate cancer; Racial disparity; Randomized controlled trial; Screening; Shared decision-making.
Shared decision-making, prostate cancer screening.

2020

Preparing African American Men to Make Informed Prostate Cancer Screening Decisions: Development and Pilot Testing of an Interactive Online Decision Aid
Effect of a Prostate Cancer Screening Decision Aid for African-American Men in Primary Care Settings

decision making (shared); decision support techniques; early detection of cancer; men’s health; minority health; prostate neoplasms.
Aging, decision making / ethics, primary health care, prostatic neoplasms / epidemiology

2019

Prostate Cancer Screening: Shared Decision-Making for Screening and Treatment

Cancer prevention; Men’s health; Prostate cancer; Screening.

2018

Physician Consultations, Prostate Cancer Knowledge, and PSA Screening of African American Men in the Era of Shared Decision-Making
Prostate Cancer Screening Patient Decision Aids: A Systematic Review and Meta-analysis

African American; health knowledge; prostate cancer health disparities; prostate-specific antigen; shared decision-making.
decision making (shared); decision support techniques; early detection of cancer;

2017

Outcomes of Prostate Cancer Screening by 5α-Reductase Inhibitor Use

5α-reductase inhibitors; Finland; mass screening; prostate-specific antigen; prostatic neoplasms.

2016

Do Men Receive Information Required for Shared Decision Making About PSA Testing? Results from a National Survey
What’s new in screening in 2015?

PSA testing; Patient-provider communication; Prostate cancer screening; Shared decision making; Uncertainty.
prostate cancer health disparities, prostate cancer screening.

2015

Prostate-Specific Antigen (PSA)-Based Population Screening for Prostate Cancer: An Evidence-Based Analysis

Prostate cancer screening; Prostate specific antigen (PSA) test.

2014

Decision making and prostate cancer screening

Informed decision making; Patient decision aid; Patient preferences; Patient values; Prostate cancer screening; Prostate specific antigen (PSA) test; Shared decision making; Values clarification.

Comparison for issue/problem (e.g., compared to what specific group for your issue/problem (C). This may be identified through your literature search [5 points].

Using a randomized controlled trial design, an innovative intervention, like the interactive online decision assistance from Study 1 (Allen et al., 2020), might be compared to routine standard care for prostate cancer screening. The conventional method without interactive decision aids, representing standard screening procedures, may be given to the control group. Alternatively, comparisons between standard decision-making procedures, instructional resources, or discussions on shared decision-making with healthcare professionals alone may be made. This enables researchers to evaluate, compared to other conventional and alternative techniques, the unique influence and efficacy of the interactive decision aid in promoting informed decision-making and patient participation.

What specific outcome are you interested in for your issue/problem (O)? Give a rationale for your identified outcome. [10 points, 5 points each]

The principal outcome measure to evaluate the efficacy of the intervention will encompass variables such as enhanced awareness of prostate cancer, heightened self-assurance in making knowledgeable screening decisions, diminished decisional dispute, and advanced engagement with the decision-making procedure. These measurements meet the objectives of the treatments outlined in the research (Allen et al., 2020; Allen, Filson, & Berry, 2020). Researchers may assess how the interactive decision aid affects African American men’s ability to make sound prostate cancer screening choices by measuring knowledge, confidence, and decisional conflict changes. Enhanced contentment indicates the intervention’s effectiveness in favorably impacting participants’ involvement and experiences during decision-making.

State a timeframe for your outcome interest (T) [4 points]? Validate this timeframe with a research study reference [6 points]. [10 points total]

The assessment of results will adhere to a planned schedule, starting with an initial evaluation before the intervention and continuing at specific intervals following the interactive decision aid’s deployment. Assessments may occur immediately following the intervention and at follow-up intervals, such as three, six, and twelve months after the intervention, due to the nature of decision-making processes and potential changes in knowledge and satisfaction. This duration enables the analysis of both immediate and long-term effects. Previous research indicates that pre/post-evaluation designs are crucial for determining the decision aid’s direct impacts (Allen et al., 2020). Furthermore, expanding the evaluation to include more time points is consistent with the requirement to comprehend the intervention’s durability and long-term impacts on patients’ contentment with prostate cancer screening and their ability to make knowledgeable decisions.

State a PICOT from your above information. Identify specific (P) (I) (C) (O) (T) components in the statement (e.g. How do 20 – 35 year old females (P) with a diagnosis of paralysis from the waist down (I), compared to 50 – 65 year old females (C), perceive their interactions with their romantic significant others (O) during the first six months following diagnosis (T)). [20 points]

In African American men aged 45 to 70 years (P), does the implementation of an interactive online decision aid (I), compared to routine standard care (C), result in increased prostate cancer awareness, enhanced trust in knowledgeable decision-making, reduced decisional dispute, higher contentment with the decision-making process (O), over twelve months (T)?

Format = 15 points. Grammar, sentence structure, writing style and APA.

Total = 100 points

References

American Cancer Society Cancer Action Network, 2023. fightcancer.orgAmerican Cancer Society Recommendations for Prostate Cancer Early Detection

Blum, K. (2023). A Disturbing RISE in Prostate Cancer: Growing incidence, especially of advanced disease, demonstrates the need for refined approaches to testing beyond PSA. Clinical Laboratory News, 8–13

Carroll, L. (2017). Should Prostate Cancer Screening be Different for Black Men? Fred Hutch Cancer Center

CDC.gov. Who Is at Risk for Prostate Cancer? | CDChttps://www.cdc.gov/cancer/prostate/basic_info/risk_factors.htm

DeSantis, C.E., Miller, K.D., Goding Sauer, A., Jemal, A. and Siegel, R.L. (2019), Cancer statistics for African Americans, 2019. CA A Cancer J Clin, 69: 211-233. https://doi.org/10.3322/caac.21555

Giaquinto AN, Miller KD, Tossas KY, Winn RA, Jemal AM, Siegel RL. Cancer statistics for African American/Black People 2022. C.A. Cancer J Clin. 2022. https://doi.org/10.3322/caac.21718

Hinata N, Fujisawa M. Racial Differences in Prostate Cancer Characteristics and Cancer-Specific Mortality: An Overview. World J Mens Health. 2022 Apr;40(2):217-227. doi: 10.5534/wjmh.210070. Epub 2022 Jan 1. PMID: 35021294; PMCID: PMC8987139.

Siegel RL , Giaquinto AN , Jemal A . Cancer statistics, 2024. C.A. Cancer J Clin. 2024; 74(1): 12-49. doi:10.3322/caac.21820