Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine; Department of Medicine, Division of Hematology/Oncology
Health Communication | Health Services Administration | Information Literacy | Neoplasms | Oncology | Public Health Education and Promotion
OBJECTIVE: Patient question-asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question-asking as a function of health literacy with respect to spoken information (health literacy-listening).
METHODS: Four-hundred and thirty-three (433) adults listened to simulated physician-patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy-listening was assessed using the Cancer Message Literacy Test-Listening (CMLT-Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT-Listening asked a similar variety of questions.
RESULTS: Questions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT-Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education.
CONCLUSION: Patients' health literacy-listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.
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Citation: Health Expect. 2016 Aug;19(4):920-34. doi: 10.1111/hex.12387. Epub 2015 Jul 22. Link to article on publisher's website
cancer screening, health literacy, patient engagement, physician-patient communication
Mazor, Kathleen M.; Rubin, Donald L.; Roblin, Douglas W.; Williams, Andrew E.; Han, Paul K. J.; Gaglio, Bridget; Cutrona, Sarah L.; Costanza, Mary E.; and Wagner, Joann L., "Health literacy-listening skill and patient questions following cancer prevention and screening discussions" (2016). University of Massachusetts Medical School Faculty Publications. 933.
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