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Gawain Williams Dissertation FINAL1.57 MB
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Dissertation
Prostate cancer care disparities: treatment gaps, access barriers, and the impact of screening recommendations on the Non-Hispanic Black community
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2026
DOI: 10.25820/etd.008456
Abstract
Prostate cancer (PCa) is one of the most frequently diagnosed cancers and a leading cause of cancer-related death among men in the United States. Non-Hispanic Black (NHB) men bear a disproportionate burden, experiencing higher incidence, earlier age at onset, and greater mortality compared to other racial and ethnic groups. While biological susceptibility has been previously identified, a growing body of work suggests that disparities in prostate cancer outcomes cannot be explained by genetics alone. Differences in screening access, timeliness of care, systemic barriers, healthcare experiences, and broader social determinants of health play critical roles in shaping outcomes for NHB men across the prostate cancer care continuum.
This dissertation examined disparities in PCa screening, treatment, and access to care among NHB men through three complementary studies. The first study evaluated racial differences in definitive treatment and time to treatment initiation in Iowa using Iowa Cancer Registry data. NHB men with advanced stage PCa were less likely to receive definitive treatment compared to (Non-Hispanic White) NHW men and experienced longer delays to adjuvant therapy, despite a higher proportion receiving care at National Cancer Institute-designated or Commission on Cancer- accredited facilities. The second study explored barriers and access challenges experienced by NHB individuals seeking cancer care in Iowa, through key-informant interviews with Black community leaders and stakeholders. The analysis identified themes related to health literacy and cultural understanding, structural barriers to care, interpersonal dynamics and communication, trust within the healthcare system, strengths and resiliencies, as well as community-based solutions for improving access to cancer care across the continuum. Comparative findings highlighted both shared and distinct experiences between African American and Black African immigrants, particularly in relation to health literacy and trust in the healthcare system. The third study evaluated the impact of the 2018 United States Preventive Services Task Force recommendation on Prostate-Specific Antigen (PSA) screening and PSA screening related conversations. Using Behavioral Risk Factor Surveillance System (BRFSS) data from 2010-2020, we applied a weighted continuous difference-in-difference approach with state and year fixed effects to examine changes in screening and shared decision making across baseline screening contexts. The findings revealed reductions in screening in previously high-screening states alongside a shift toward more balanced shared decision making. Together, these studies demonstrated the impact of the differences in treatment patterns, care access, and communication contribute to persistent disparities in PCa outcomes, offering evidence to inform future clinical practice and policy aimed to strengthen shared decision-making guidelines, improve equitable access to timely and high-quality cancer care, and support targeted, community-informed interventions to reduce disparities in PCa outcomes.
Details
- Title: Subtitle
- Prostate cancer care disparities: treatment gaps, access barriers, and the impact of screening recommendations on the Non-Hispanic Black community
- Creators
- Gawain Javon Williams
- Contributors
- Whitney E. Zahnd (Advisor)George Wehby (Committee Member)Dan Shane (Committee Member)Mary Charlton (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health Services and Policy
- Date degree season
- Spring 2026
- DOI
- 10.25820/etd.008456
- Publisher
- University of Iowa
- Number of pages
- xvi, 170 pages
- Copyright
- Copyright 2026 Gawain Javon Williams
- Language
- English
- Date submitted
- 04/15/2026
- Description illustrations
- Illustrations, graphs, charts, tables
- Description bibliographic
- Includes bibliographical references (pages 166-170).
- Public Abstract (ETD)
Despite advances in cancer detection and treatment, prostate cancer (PCa) continues to impact some population groups more than others. Non-Hispanic Black (NHB) men experience higher rates of new PCa cases, delayed treatment, and poorer outcomes compared to other racial groups. These poorer outcomes may be due to differences in access to care, healthcare experiences, and broader social and structural conditions.
This dissertation examined the differences in PCa treatment, and screening, as well as the access challenges and barriers faced by NHB population in seeking cancer related care. The first study examined the differences between NHB and non-Hispanic White (NHW) Iowan men in the likelihood of receiving curative treatment and the timeliness of this treatment. Results showed that NHB men with an advance stage of PCa were less likely to receive curative treatment compared to their NHW counterparts and this varied based upon the type of hospital where they received their care. The second study looked at further understanding the specific barriers and access challenges experienced by NHB individuals seeking cancer care in Iowa. This study also sought to delineate the specific barriers and access challenges by specific populations: African American and Black African immigrants. The major themes identified from this study were related to understanding the healthcare system, systematic access challenges, communication with care providers, and trust, while also highlighting community-based solutions to the challenges. The third study evaluated how national screening recommendations influenced PCa screening and patient-provider conversations. These findings provided early evidence of declines in screening in some geographical areas alongside improvements in more balanced discussions about screening decisions.
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9985177075802771
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