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They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient\u2013provider communication contributes to suboptimal care, which can be exacerbated by patients\u2019 limited health literacy, providers\u2019 lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Using an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients\u2019 understanding of their diagnoses and treatment options, sources of support in decision-making, patient\u2013provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients\u2019 experiences and providers\u2019 perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>To our knowledge, this is the first study to examine in-depth patient\u2013provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035032","type":"journal-article","created":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T01:45:24Z","timestamp":1596678324000},"page":"e035032","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Ethnographic investigation of patient\u2013provider communication among African American men newly diagnosed with prostate cancer: a study protocol"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5311-447X","authenticated-orcid":false,"given":"Nynikka R","family":"Palmer","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA"},{"name":"Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA"},{"name":"Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet K","family":"Shim","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia P","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA"},{"name":"Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Schillinger","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA"},{"name":"Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah D","family":"Blaschko","sequence":"additional","affiliation":[{"name":"Division of Urology, Highland Hospital, Oakland, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin N","family":"Breyer","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rena J","family":"Pasick","sequence":"additional","affiliation":[{"name":"Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA"},{"name":"Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,8,5]]},"reference":[{"key":"2025121514234355000_10.8.e035032.1","doi-asserted-by":"crossref","unstructured":"Epstein RM , Street RL . 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