Disparities in Men’s Health

RELEASE DATE

June 1, 2023

EXPIRATION DATE

June 30, 2025

FACULTY

Justin J. Sherman, PharmD, MCS
Associate Professor of Pharmacy Practice
University of Mississippi School of Pharmacy
Jackson, Mississippi

FACULTY DISCLOSURE STATEMENTS

Dr. Sherman has no actual or potential conflicts of interest in relation to this activity.

Postgraduate Healthcare Education, LLC does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced, objective, and scientifically rigorous. Occasionally, authors may express opinions that represent their own viewpoint. Conclusions drawn by participants should be derived from objective analysis of scientific data.

ACCREDITATION STATEMENT

acpePharmacy
Postgraduate Healthcare Education, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

UAN: 0430-0000-23-060-H01-P
Credits: 2.0 hours (0.20 ceu)
Type of Activity: Knowledge

TARGET AUDIENCE

This accredited activity is targeted to pharmacists. Estimated time to complete this activity is 120 minutes.

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DISCLAIMER

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

GOAL

To discuss the cause and effect of racial disparities in men’s health, with a focus on prostate cancer. Possible solutions within the context of the pharmacy profession will also be discussed.

OBJECTIVES

After completing this activity, the participant should be able to:

  1. Discuss the possible sources of racial disparity for prostate cancer, including socioeconomic, environmental and lifestyle, discrimination within healthcare settings, and pathogenic differences.
  2. Evaluate the reasons for and implications of disparities that occur in clinical trial enrollment of different ethnicities.
  3. Describe the screening and treatment paradigms for prostate cancer in African American patients, including recent findings regarding metastatic castrate-resistant prostate cancer.
  4. Explain the role of the pharmacist, both on the systems and individual levels.

ABSTRACT: While prostate cancer is the second-leading cause of death in men in the United States, the African American population experiences a 2.1-fold increased risk of death. The reasons are multifaceted. This population experiences socioeconomic and environmental disparities, along with the screening and treatment of prostate cancer. They must also combat differences in prostate disease pathogenesis and even discrimination within the healthcare setting itself. Fortunately, there are some encouraging findings regarding the treatment of metastatic castrate-resistant prostate cancer in recent studies. Pharmacy education should include tenets of cultural sensitivity, and pharmacists should maintain introspection when communicating with a diverse patient population.

The root causes of racial disparity in prostate disease result from multifaceted and complex issues. Racial disparity exists in the epidemiology, diagnosis, and management of prostate cancer.1,2 This disparity may result from differences in pathogenesis and racial discrepancies in clinical trial enrollment; however, other factors include socioeconomic status, environmental and lifestyle discrepancies, and bias within healthcare settings. The objective of this review is to discuss the factors contributing to racial disparities and to outline possible solutions in the context of the pharmacy profession. Implications for pharmacists, both on systems and individual levels, will be discussed.

SOURCES OF DISPARITIES

Socioeconomic Disparities

Populations who have inadequacies in healthcare access and who are socioeconomically disadvantaged—including income, education, and occupation—tend to have a disproportionate disease state burden.3 Lower income and educational attainment tend to result in lower access to quality healthcare.4 In addition, lower educational attainment may lead to less access to social support. Certain occupations can also expose those workers to higher levels of carcinogens, which may lead to an increased disease risk. Those with lower income and/or who are inadequately employed tend to have less health insurance. This leads to less ability to complete cancer screening, delaying diagnosis, and presenting with more advanced disease. More aggressive treatment is required for patients presenting with advanced disease, with fewer treatment options and a worse prognosis. Over 473,000 patients aged 18 to 64 years having the 10 deadliest forms of cancer participated in one study.5 Patients with Medicaid coverage or without insurance were more likely to present with advanced cancer. Surgery directed at cancer, with or without radiation therapy, was less likely for this population, with a higher risk of death. In addition to the objective measures of socioeconomic status, some evidence exists that subjective measures can impact disease burden as well. In other words, one’s perception of his or her current and future position in society compared with others could be linked with physical health, such as psychological distress and negative coping strategies.6

Environmental and Lifestyle Disparities

Men who live in impoverished areas are more likely to die of cancer, including prostate cancers.7 In addition to limited healthcare access, African Americans living in highly segregated areas may experience higher poverty levels, poor housing quality and neighborhood safety, and limited education and employment opportunities.8 With limited employment opportunities, insurance attainment is less likely. After controlling for socioeconomic status and health insurance, a recent systematic review found that residential segregation contributed to racial disparities of cancer.9 Other risk factors specific to prostate cancer may result from higher environmental toxin exposures. For example, higher traces of cadmium in the blood—one purported risk factor for prostate cancer—can be found in African Americans versus Caucasians.10,11

Additionally, African Americans tend to have higher disparities in prostate cancer comorbidities.7 They have a disproportionate percentage of the population with diabetes and cardiovascular disease, which increases their risk of death versus their Caucasian counterparts, and they are less likely to receive education regarding treatment options for concomitant prostate cancer.7 They are also less likely to be included in shared decision-making discussions. These are discussions through which both the patient and the provider are involved in making treatment decisions.

Healthcare Settings and Social Disparities

Implicit racial bias likely results in treatment disparities, which is beginning to be addressed by the healthcare community. Clinicians should be aware of their patients’ perceptions of the healthcare system—especially for prostate cancer where shared decision-making discussions should involve the patient. For example, one study investigated whether patient-oncologist interactions negatively affected patients’ perceptions of treatment options.12 Researchers recorded and analyzed the content of discussions of 18 Caucasian oncologists and 112 African American patients. Nonbiased observers ranked communication with regard to information and support provided, partnership building, and time of interaction. Investigators surveyed the patients about distress, trust, and treatment perceptions. The conclusion, published in the Journal of Clinical Oncology, was that the oncologists’ implicit racial bias was associated with poor communication and patients’ perceptions of recommended treatments.

This study has not been the only one regarding communication issues between African American men and their providers. African American men, compared with their Caucasian counterparts, report poorer communication regarding prostate-specific antigen (PSA) screening.13 Furthermore, a retrospective analysis revealed that prostate cancer screening among African American men is influenced heavily by information received from family, community members, and pastors.14,15 African American men report, in general, more distrust of the healthcare system compared with other racial groups. They are more likely to report fear that screening for prostate cancer will not be thorough, with misuse of personal test results.16 Also, speaking with healthcare providers of a similar culture and ethnic background is important.17 This is part of the systemic problem, as well, since only 6.2% and 5% of medical school graduates and active clinicians were African American in a report by the Association of American Medical Colleges in 2019.18

PATHOGENESIS OF PROSTATE DISEASE

Ongoing research is showing that diseases of the prostate may have heritability and a pathogenic basis. This may lead to disparity in certain populations. For example, the transition zone index (TZI) of the prostate describes the ratio of transition zone volume to prostate volume as a whole and may predict higher PSA scores and larger total cancer volumes.19 When a comparison was made of African American, Hispanic American, and Caucasian men with urinary symptoms, the investigators found that African American men had a significantly greater TZI versus all other counterparts.20 In another study, researchers found that the prostates of Japanese men had less stromal density and greater glandular lumen compared with both African Americans and Caucasians.19

A polygenic risk score can determine an increased risk for developing a disease based on the total number of genetic changes related to the disease. Prostate cancer, for example, has the highest heritability of any cancer.21 Multiethnic populations have had a replication of 269 single nucleotide polymorphisms (SNPs). African American men display a higher 269-SNP polygenic risk score. Although it equally predicts both lethal and nonlethal forms of prostate cancer, the polygenic risk score may partially explain the racial disparity in incidence of prostate cancer.

The androgen receptor (AR) gene mediates the effects of androgens on prostate tissue. The frequency of cytosine, adenine, and guanine (CAG) repeats in the AR gene has been reported as a factor for prostate diseases, including an increased risk of prostate cancer.22 A polymorphic CAG triplet repeat, numbering between 10 and 36 in the normal population, can be found at the 5' end of exon 1 of the AR gene.23 Shorter CAG repeat lengths may be related to stronger transcriptional activity of the AR gene and lead to a higher risk of prostate cancer.22 While African American men have the highest frequency of short CAG repeat lengths, scientists cannot show a direct causal relationship between CAG repeat lengths and increased severity of prostate diseases.24

Testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5α reductase. An increased concentration of DHT in the prostate is associated with increased risk of prostate diseases. African American men have the highest DHT testosterone ratio.22 In one study of African American males, higher circulating testosterone concentrations were found versus other races from birth to age 35 years.25 Biopsy specimens were taken in another study that found African American men to have more stroma-glandular component ratios compared with Japanese men.26 Of note, Japanese men tend to have lower rates of prostate cancer in comparison to African Americans, Hispanic Americans, and Caucasians. Prostate cancer is multifactorial regarding development; however, the TZI, polygenic risk scores, CAG repeats, and hormonal differences may account for some of the racial disparity found in this disease state.

CLINICAL TRIAL DISPARITIES

A final but important source of disparity resides in the fact that African American and minority participants have been historically underrepresented in the conducting of significant clinical trials. Rencsok et al reviewed 72 phase III and IV clinical trials of prostate cancer screening, prevention, and treatment, with over 809,000 participants included.27 They found that approximately 1.36% were African American despite the known racial disparities of prostate cancer clinical outcomes. While this study identifies the problem on a broad level, trial enrollment of minority participants for novel metastatic treatments also remains alarmingly low, especially since an unprecedented increase in treatment options has occurred in the past decade. These treatment options include sipuleucel-T, radium-233 chloride, enzalutamide, abiraterone, and cabazitaxel. Spratt and Osborne reviewed phase III randomized, controlled trials, including over 7,200 men, that resulted in FDA approval of novel therapies for castrateresistant prostate cancer. Less than 3.3% of the men in these trials were African American.28 On further analysis of the randomization processes of these trials, they discovered that only 150 African American men actually received the investigational intervention. Such a low percentage of African American men receiving therapy means that a subgroup analysis and assessment of efficacy for this population cannot be performed.

Perceptions persist that African American and minority patients are less willing to participate in clinical trials and to comply with complex treatment measures.29,30 Rivers et al conducted a systematic review that found barriers for enrolling African Americans into cancer clinical trials included negative attitudes toward clinical trials, low levels of awareness regarding trials, and religious beliefs.30 Other research suggests that no association between race and desire to participate in research exists.31 In fact, a validated questionnaire administered to 900 respondents in a three-city area found that while African Americans and Hispanic Americans do report a higher fear of participation in clinical trials versus Caucasians, they are just as likely to participate if asked. However, structural barriers to clinical trial participation have been identified. These include the lack of transportation, childcare, poverty, healthcare access, health insurance, and comorbidities.

In response to these identified disparities, National Cancer Institute (NCI)–designated centers have developed an action plan to increase participation among minorities.28 Changes include center-wide policy changes, follow-up with clinical investigators, infrastructural process control, data analysis, and reporting. Patient navigation programs have been created with community health workers and other navigators hired to increase access to and knowledge of clinical trials. Twelve percent of the American population is African American, with this population having more than a twofold risk for castrate-resistant prostate cancer. Thus, 24% of the participants in clinical trials being African American would be ideal representation. Other solutions have been proposed, including advertisement as to the importance of clinical trials, encouragement from physicians, family, and friends, providing transportation and parking, having availability during nontraditional hours, and fostering cultural sensitivity among researchers and healthcare providers.29

PROSTATE CANCER

Incidence of prostate cancer continues to increase every year in the United States, with projected estimates in 2023 at 288,300 cases and 34,700 deaths.32 One in eight men will be diagnosed with prostate cancer in his lifetime. It continues to be the second leading cause of death in men, behind only lung cancer. African American men experience a higher degree of disease burden compared with Caucasians, with 60% greater incidence and a 2.1-fold higher risk of death. Mortality rates for African Americans, American Indians, Hispanic Americans, and Asian Americans are 37.5%, 21.9%, 15.3%, and 8.6%, respectively, versus 17.8% for Caucasian men.32 African Americans are also more likely to develop prostate cancer at almost every stage of the disease continuum and at every decade of life.33 This group of men also tends to present with prostate cancer an average of 2 years earlier than Caucasian men. Higher morbidity and mortality rates may likely be due to African American men being diagnosed with more aggressive disease and/or at later stages.34 This contributes to fewer treatment options, as well.

Screening

While prostate cancer screening remains lower among African American men compared with Caucasians, the United States Preventive Services Task Force (USPSTF) lacks recommendation specificity regarding this high-risk population.35 In 2012, the USPSTF recommended against yearly PSA screening, citing the harms of screening. Those harms include pain, fever, bleeding, infection, and transient urinary difficulties associated with prostate biopsy, psychological harm of false-positive test results, and overdiagnosis. In addition, overtreatment of cancer that is not likely to lead to mortality could lead to increased posttreatment urinary incontinence and erectile dysfunction. Subsequent to the USPSTF recommendation, overall screening frequency declined by 11.6% and 9.3% in African American and Caucasian men, respectively.36 In 2018, the USPSTF updated its recommendation. Men aged 55 to 69 years should be screened selectively based on shared decision-making between the patient and healthcare provider.37 The 2018 update also identified that African American men and men with a family history of prostate cancer would have a higher risk. Thus, the 2018 update supported inclusion of patients in making informed decisions about screening. Men should be encouraged to discuss the pros and cons of PSA screening with their physicians to make the best choices in an environment of shared information.

Of interest, neither USPSTF recommendation made specified statements for screening African American men yearly or otherwise, citing the lack of data for risks and benefits of screening for this population. Four of the most well-known screening trials underrepresented African American participants. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, the European Randomized Study of Screening for Prostate Cancer, the Cluster Randomized Trial of PSA Testing for Prostate Cancer, and the Norrkoping randomized prostate cancer screening trial included more than 746,000 participants. Only 3,375, or 0.4%, were African American.38

The American Cancer Society recommends that high-risk men (African American men and those with a first-degree relative with current/history of prostate cancer) should discuss with their healthcare provider, as part of an informed decision process, whether to be screened from age 45 years.39 A shared decision-making process regarding screening is also recommended by the American Urological Association (AUA). The AUA suggests this starting at age 55 to 69 years for men at intermediate risk and who are considering PSA testing. At ages 40 to 54 years, the AUA does not suggest routine PSA testing for those at average risk. However, for those at higher risk and younger than age 55 years, the AUA advocates that decisions regarding screening should be individualized in a shared decision-making process. The healthcare provider should give information regarding risks, potential benefits, and uncertainties behind screening and possible treatment options.39

As already discussed, this disparity in PSA screening results in increased tumor volume at the time of diagnosis, need for more aggressive treatment regimens, and increased morbidity and mortality in African American men. In contrast, a study was conducted for annual screening in this population of men aged 45 to 69 years that resulted in positive treatment of prostate cancer without overscreening and overtreatment.40 Other research has suggested that combining PSA testing with genetic risk profiling, as discussed earlier, has the potential to better influence screening and treatment in higher-risk patients, including African American men.39 Thus, screening practices that stratify by risk of disease versus harms may have the potential to reduce mortality among this population. Additional studies are needed in this area.

Treatment

African American men, as well as decreased healthcare access and the increased likelihood of being uninsured or underinsured.38 Mahal et al analyzed over 138,000 patients with nonmetastatic high-risk prostate cancer.41 They found that minority and uninsured patients were not as likely to receive definitive treatment and, if they did, were more likely to experience delay in treatment. Also, treatment is unclear for African American men who have been diagnosed with clinically low-risk prostate cancer. For most men with low risk, active surveillance (AS) is the standard of care. However, in one systematic review, African American men with initially low-risk prostate cancer were more likely to have tumor upgrading or higher tumor volume.42 As a result, clinicians may not recommend AS for low-risk African American men due to fear of missing cancer that quickly may become more significant.

Prostate cancer guidelines recommend definitive treatment for men with intermediate and high-risk prostate cancer, as long as life expectancy dictates such treatment.38 However, in the Surveillance, Epidemiology, and End Results study, clinicians were less likely to provide definitive treatment for African American and Hispanic American men.43 This decreased likelihood of treatment persisted—and even worsened—with an increased risk category. Finally, those who received definitive therapy were less likely to receive radical prostatectomy.

Deka et al published an interesting study in the Journal of the American Medical Association (JAMA).43 They conducted a retrospective cohort study within the Veterans Health Administration that followed over 8,700 men with low-risk prostate cancer through AS. Over a 10-year period, they found a statistically significant increase in cumulative incidence of disease progression for African American men (59.9%) versus Caucasian men (48.3%) and for definitive treatment (54.8% vs. 41.4%). However, they did not find an increased incidence of metastasis or mortality specific to prostate cancer for African American men. Of note, 2,280 African American men were included in this study, which at the time of this writing is the largest sample of participants in an AS study. The authors suggested that as the study was conducted with participants within the Veterans Affairs system, the results reflect cancer management in an equal-access setting. Thus, improvement in access may not, by itself, reduce the disparity in disease progression. This may suggest, as stated earlier, that biological differences in development of prostate cancer in this population may still need to be considered. Due to not finding an increased risk of metastasis or prostate cancer mortality, these authors stated that AS protocols should not necessarily exclude African American men. However, other scientists interpret these findings as meaning that equal access may help ameliorate some disparity and that African American men may not harbor more aggressive disease that remains undetected.35,38,44

Regardless of the JAMA study, discussion centers around the disparity of reduced survival in African American men with prostate cancer. However, evidence is emerging that—with regard to metastatic castrate-resistant prostate cancer (mCRPC)—this patient population may experience more benefit than other races.44 In two meta-analyses, one using docetaxel and one using radium-223, African American men versus Caucasians experienced an increased survival rate.45,46 In the docetaxel study including 500 African American and 7,528 Caucasian men, the former group exhibited a 19% reduced risk of death.45 The Veterans Affairs study using radium-223 also had a reduced risk of death despite the fact that the group of African American men had higher baseline PSA and alkaline phosphatase concentrations.46

At the time of this article, the largest known racial difference in survival for mCRPC treatments favoring African American men is in a PSA-matched cohort from the Provenge Registry for the Observation, Collection, and Evaluation of Experience Data.47,48 This study evaluated the use of sipuleucel-T, an autologous cellular immunotherapy used for treating men with mCRPC. It included 219 African American and 438 Caucasian men. The median survival for African American men was 9.5 months longer with a 40% reduced risk of death compared with the group of Caucasian men. Other retrospective studies have been conducted reviewing the use of other mCRPC treatments like abiraterone and enzalutamide.49,50 Some researchers suggest that, together, these retrospective data may suggest that African American men may respond better than their Caucasian counterparts to some mCRPC treatments.44

A prospective multicenter study has been conducted in 50 African American men and 50 Caucasian men with mCRPC receiving abiraterone acetate and prednisone.51 In this first completed race-stratified pilot study in men with mCRPC, time to PSA progression was shown to be 5 months longer in African Americans with higher rates of PSA concentration decline. However, the adverse-effect profile was also higher for African American men experiencing hypertension and hypokalemia. The researchers stated that these emerging data should be explored more fully in context with several genomic alterations in African American men, which may be different from their Caucasian counterparts.44 Also, a multitude of other reasons, including lifestyle, social, and other biological factors, should be explored.

ROLE OF THE PHARMACIST

Implications on a Systems Level

The Accreditation Council for Pharmacy Education Standards 2016, accreditation standards used for all U.S. colleges of pharmacy, specifically state that cultural sensitivity, health disparity, health inequities, and social determinants of health should be integrated into the curricula.52 Pharmacists, having roles within the community and on healthcare teams, are well positioned to address healthcare disparities.53 Identifying this gap in widespread implementation of these concepts, educators are calling for curricula incorporating health disparities and cultural competence to be intentional, integrative, and comprehensive. They cite that such teaching has been within “silo” classes and are calling for a programmatic approach that is introduced and reinforced, vertically and longitudinally, throughout all academic areas and within all pharmacy disciplines. The American Association of Colleges of Pharmacy held an equity, diversity, and inclusion institute in 2021 to develop a framework for supporting an inclusive campus environment.53 Key to creating such an environment, as identified at this institute, was incorporating cultural competency training.

In a comprehensive review of teaching within the U.S. colleges of pharmacy, Drame et al found that activities that are effective include case-based and community engagement exercises.54 To incorporate health-disparities concepts more fully into experiential education, this review identified that preceptor development should include increasing student engagement and cross-cultural communication with diverse patient populations at sites. Flexibility in class programming was found more often in cocurricular and interprofessional parts of the curriculum. Teaching methods in these classes included service learning, symposia, study abroad, and forums. In a Pharmacy Skills and Application Course series in one college of pharmacy, activities were integrated on cultural competency throughout the PharmD curriculum.55 Activities included lecture, service-learning, case studies, discussion, and reflection. In a pre- and post-questionnaire, the authors found that scores evaluating cultural skills and cultural encounters were significantly higher after completion of the course series. However, increased knowledge and abilities in all areas were not found.

Finally, educators have discussed that appropriate assessment tools for teaching cultural competence should be identified.56 In a review of these tools, Medina et al found 12 assessment tools but stated that they varied widely and that no one tool can currently assess all aspects of cultural competency within all programs in colleges of pharmacy. Pharmacy students should be trained in cultural competency to help alleviate racial disparity once they take pharmacy roles within their communities. At this time, more research needs to be done to identify “best practices” that can be implemented and assessed throughout the curricula of the colleges of pharmacy.

Implications on an Individual Level

Standardizing coursework and other educational opportunities to help alleviate health disparities is necessary. However, individuals may not truly develop an appreciation, and then the knowledge, skills, and abilities necessary for helping their patients within the pharmacy, until working with a diverse culture in practice.57 Pharmacists must embrace diversity to provide a higher quality of care for all patients. As discussed throughout this activity, the causes of disparities are multifactorial and complex, and more research is needed. Pharmacists must recognize that diverse populations have unique needs and must develop the ability to adapt the care they provide accordingly by attaining cultural competence.58

To become culturally competent, pharmacists should 1) understand that patients’ health beliefs and behaviors are influenced through social and cultural norms; 2) consider how these factors interact throughout the healthcare-delivery system—especially within their own pharmacies; and 3) ensure quality healthcare delivery to diverse patient populations by devising interventions that take these issues and factors into account.59 Pharmacists should remember that cultural competence is a journey where they will continually learn. Also, patients should not be stereotyped or generalized. Rather, the individual’s needs, regardless of race, ethnicity, religion, or sexual preference, should always be considered to achieve positive therapeutic outcomes.

A good starting point for pharmacists is to learn about themselves.57 What are the individual pharmacist’s own values and beliefs? What are the historical roots and what role has culture played in and shaped the pharmacist’s own life and current beliefs about culture’s impact on health? Then, the natural next step would be to identify the key cultures served within that pharmacy or pharmacy system.58 Learning the different cultures and backgrounds of the patients served by that pharmacy can help the pharmacist be more prepared to treat each patient culturally, professionally, and individually.57

Identifying and overcoming barriers are also important aspects that will help the pharmacist become more culturally competent. For example, five common barriers to the use of pharmacy services were found in a survey of a minority population.60 These barriers included finances, language, transportation, physical illness, and unemployment. Pharmacists could become familiar with local programs or organizations that ease financial barriers. Of course, patient-assistance programs and downloading cards from pharmaceutical-company websites are classic ways of helping patients. Interpreter services are available to assist with language barriers. Local transportation services could ease problems of access, and offering delivery services or home care would be optimal.58 Pharmacists could partner with local home healthcare agencies to assist with barriers due to physical illness. Increasing adherence to medications and working as closely as possible with providers to optimize medication-therapy strategies are also obvious ways to help alleviate the physical-illness barriers.

While many barriers result from limitations that the patient has, pharmacists themselves may need to overcome their own barriers. Pharmacists may need to be introspective about the way they communicate, as well. Communicating with a diverse patient population necessitates understanding of delivered verbal and nonverbal cues. Interpersonal space and gender roles should also be considered. Some common barriers for pharmacists communicating in a culturally competent manner include:

  • Using inadequate language. The pharmacist may not feel that the right words and phrases are being used for the patient. The more the pharmacist knows the patient, the easier it will be select the most appropriate language and choose the best words when counseling.61
  • No time for counseling. Pharmacists often feel that they are too busy to counsel adequately. Remember that any counseling, however limited in amount, is better than no counseling. It is important, and over time the effort made for counseling will pay dividends. Counseling in a friendly, encouraging, nonjudgmental, and personable manner, over a period of time and with intention, will help that pharmacist best know how to help the individual patient.
  • Making mistakes with addressing people. Pharmacists often encounter unfamiliar names or words. Pharmacists should be respectful when addressing patients, always with an intent to promote a sense of belonging rather than emphasizing differences. Genuinely trying to pronounce names correctly gives a person dignity and respect. Also, using the correct pronouns for the patient is important, as gender-identity matters have become more prevalent in society. Using gender-neutral terms until the person’s gender identity is known is fine. Another solution, both for pronouncing names and using the correct gender-identity terms, is to simply ask politely how the person would like to be addressed.61

Overall, pharmacists who work diligently to attain an awareness of their own interactions and the needs of the diverse patient populations whom they help will develop the trust of their patients, optimize medication adherence, and achieve therapeutic goals.

CONCLUSION

Prostate cancer is the second leading cause of death in the U.S. for men. The African American population experiences a 2.1-fold higher risk of death due to a variety of reasons, ranging from biological and socioeconomic differences to disparities within the healthcare setting itself. More research must be done in this area, especially with regard to encouraging results for patients with mCRPC. The pharmacy profession and pharmacists themselves, while at the front line of care, need to seek cultural competence to help alleviate some of these disparities.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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