Online Program

Improved Accuracy of PSA Self-Reports Among Low-income, Uninsured Men after a Public Health Nursing Intervention

Sunday, November 1, 2015

Mary Wassel Zavala, LCSW, MPP, MA, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
Arthur Yule, BS, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
Lorna Kwan, MPH, Department of Urology, David Geffin School of Medicine at UCLA, Los Angeles, CA
Sally L. Maliski, RN, PhD, FAAN, School of Nursing and Department of Urology, University of California, Los Angeles, Los Angeles, CA
Sylvia Lambrechts, MPH, MA, Department of Urology, David Geffen School of Medicine at UCLA, University of California Los Angeles (UCLA), Los Angeles, CA
Mark S. Litwin, MD, MPH, Urology and Health Services, David Geffen School of Medicine at UCLA, Los Angeles, CA
background:  We examined the accuracy of patient-reported prostate-specific antigen (PSA) levels among indigent, uninsured men in a state-funded prostate cancer treatment program providing case management, care coordination and health education. We made assessments at enrollment and again at the next PSA measurement to determine accuracy before and after exposure to the program’s nursing interventions, designed to target barriers to care including language and education.

methods:  Among enrolled men, we sampled 131 with matched self-reported and lab-reported PSA levels for the same lab draw within 3 months of program entry (baseline).  Of these, 62 had a second matched self-report and lab-report PSA measurement within 6 months of the first PSA.  Patient-reported values were compared with lab-reported results (ng/mL) as absolute differences.  Characteristics were compared between men categorized as accurate (zero difference) or inaccurate (difference >0) at each time point.   

results:  At baseline, men averaged 59.2 years of age and 50% were Hispanic. 41% (n=54) of men reported accurate values. Among the 77 (59%) with inaccurate self-reports, the mean (SD) absolute difference was 17.2 (106.2) and the median 0.90. Despite no difference in age, race, language, income, and comorbidity between both groups, language was found significant in the multivariate regression.  Men with inaccurate self-reports were more likely to be English-speaking (OR=0.38, 95% CI 0.14-0.88). At follow-up, 56% (n=34) were accurate vs. 41% at baseline (p=0.0602).

conclusions: Exposure to the program’s nursing intervention was associated with improved PSA reporting accuracy.  English speakers less accurately reported PSA results at baseline.

Learning Areas:

Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Implementation of health education strategies, interventions and programs
Public health or related nursing

Learning Objectives:
Describe the nursing model and educational interventions used with low-income, uninsured men with prostate cancer. Compare the accuracy of patient-reported to lab-reported prostate specific antigen values in this cohort. Identify the subgroups that may benefit from targeted intervention regarding disease knowledge and health literacy.

Keyword(s): Health Promotion and Education, Health Literacy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have extensive experience overseeing quality of care delivery projects for patients with prostate cancer.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.