Donald E. Gelfand

Outcome of African American Men Screened for Prostate Cancer: The Detroit Education and Early Detection Study

PURPOSE Will early detection impact on stage of disease and recurrence of prostate cancer in a high risk population? We initiated a community based study to educate and recruit African American men for early diagnosis of prostate cancer, that is the Detroit Education and Early Detection (DEED) study. Our objective was to evaluate our recruitment process for this target population, examine the percentage of organ confined prostate cancer in men undergoing radical prostatectomy and measure recurrence biochemically. MATERIALS AND METHODS A community based study from February 1993 to February 1995 through the African American churches in metropolitan Detroit was initiated. We compared the early detection group treated with radical prostatectomy to the population presenting to our urological clinic during the same period. We tested and followed 1,105 African American men using the prostate specific antigen blood test. RESULTS Pathologically organ confined prostate cancer was diagnosed in 11 of 17 men (65%) who underwent radical prostatectomy in the DEED project. Within the clinic population 35% of the African American men were diagnosed with pathologically organ confined prostate cancer. The difference between the 2 populations was statistically significant (p = 0.033). Disease recurred in 1 of 15 (7%) and 39 of 157 (25%) men in the DEED and clinic populations, respectively (p = 0.97). CONCLUSIONS We demonstrated our ability to recruit African American men into a prostate cancer early detection program. We diagnosed early but clinically significant prostate cancers among African American men with characteristics similar to prostate cancers diagnosed in other early detection studies in which the overwhelming majority of men were white.

Mexicans and care for the terminally ill: Family, hospice, and the church:

The structural barriers to the use of hospice services by minority groups have been widely discussed. The attitudes of these groups are less clearly delineated. A series of focus groups with Mexicans was held in Michigan and Arizona. The participants were between the ages of 45 and 64 or over, as well as providers of services to Mexicans. Regardless of length of time in the United States, participants were low on acculturation scores. These groups found important attitudes about the roles of the family, hospice services, and spirituality and the church in providing care to terminally ill individuals.

A successful recruitment process of African American men for early detection of prostate cancer

Background. The Detroit Surveillance, Epidemiology, and End Results program data reports prostate cancer mortality rates that are two to three times higher for African American compared with white American men between the ages of 50 and 70 years. Several investigators believe this is a result of advanced presentation of the disease secondary to a lack of early detection participation. Attempts to recruit African American men into early‐detection programs have been unsuccessful. A successful process by which to achieve this objective is presented.

Issues in Hospice Utilization by Mexicans

The research examines the limited use of hospice programs byMexicans—the largest Latino population in the United States. Factors in the use of hospice services, the role of hospice staff in the provision of services, and the most effective means of communicating information and promoting hospice use among Mexicans were examined. Focus groups stratified by two age cohorts and length of residence in the United States were held with Mexicans in Arizona and Michigan. Eight groups were held with community residents and two groups with providers of services to theMexican community. Factors inhibiting use of hospice services by Mexicans include knowledge of hospice programs, fear of discrimination by agencies, possible cost of hospice services, and language issues. Factors encouraging hospice usage were also cited. Hospice staff needs to understandMexican culture, provide good care, and encourage the patient. A number of approaches to promoting hospice use, dispelling myths about hospices, and providing information about hospices were suggested. Structural factors as well as attitudes are thus crucial in determining hospice usage by this important group.

Immigration, the Family, and Female Caregivers in Australia

Immigration in the United States increased dramati- cally during lhe 1980s but its meaning for the field of aging has not been fully explored. This article explores the impact of immigration on first-generation immigrant women in Australia who are providing care for their parents. The women are from a variety of European and Asian countries. They must not only provide care for their par- ents but must also mediate conflicts between their parents, their spouse, and their children. The intergenerational issues found in this s~tuation have implications for social work services in the United States.

Developing end-of-life interdisciplinary programs in universitywide settings.

Interdisciplinary programs in end of life are widely discussed as valuable, particularly approaches to end-of-life care. Despite this emphasis, interdisciplinary programs have not been easy to implement. In universities, the implementation of interdisciplinary programs encounters administrative obstacles, including credit for the time spent in these group efforts and “ownership” of interdisciplinary courses (IDCs). This article details the process of development and the activities of an end-of-life interdisciplinary program at one urban university with a major medical center. The issues faced in the first year are examined. These included trust, group identity, and communication. The lessons from the first-year activities are presented and efforts of the second year described.

Book Reviews : Deborah K. Padgett (Ed.). Handbook on Ethnicity, Aging and Mental Health. Westport, CT: Greenwood, 1995. 347 pp.,

&dquo;Handbooks&dquo; are usually expected to provide up-to-date summaries of the current states of knowledge in particular fields of knowledge. The editor of this handbook views it as a &dquo;resource for a broad audience of persons&dquo; including a variety of practitioners and professionals. The book is also intended to fill the &dquo;gap in the literature&dquo; about mental health, aging, and ethnicity. Based on this promise, we can expect that the handbook will present the latest data on its chosen topic. We may also expect that the handbook will meet this agenda at a reasonable cost for the practitioners and researchers who are its target audience. Although more useful for researchers and educators than for practitioners, this handbook does meet many of its goals. It is divided into four parts, with part 1 examining various approaches to ethnicity, aging, and mental health; part 2 examining the mental health needs of various groups of ethnic elderly; part 3 examining the mental health service usage patterns of ethnic elderly; and part 4 examining a variety of other issues, particularly caregiving and mental health among ethnic elderly. The editor provides a final summary chapter. Many of the chapter authors will be familiar