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

Br J Gen Pract. 2015 Mar;65(632):e161-70. doi: 10.3399/bjgp15X683965.


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 late-stage presentation at diagnosis and subsequent poorer outcomes.

Keywords: ethnic groups; primary health care; prostate cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Continental Ancestry Group*
  • Early Detection of Cancer / methods*
  • European Continental Ancestry Group*
  • Health Status Disparities
  • Humans
  • Male
  • Middle Aged
  • Minority Groups / statistics & numerical data*
  • Neoplasm Staging
  • Patient Preference / ethnology*
  • Patient Preference / psychology
  • Patient Preference / statistics & numerical data
  • Primary Health Care*
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / psychology
  • United Kingdom / epidemiology