Health Literacy and Shared Decision Making for Prostate Cancer Patients with Low Socioeconomic Status

Abstract

Quality of life (QOL) considerations are important in the treatment decision making process for prostate cancer patients. Although patient involvement in the treatment decision process has been encouraged, low health literacy can limit patient understanding of the complex information about treatments and their probable QOL outcomes and is a barrier to patient participation in the decision-making process. The objectives of the study were to evaluate (i) knowledge, level of satisfaction, and treatment preferences and intentions of men newly diagnosed with prostate cancer after participation in a CD-ROM shared decision making program; and (ii) the relationship between prostate cancer knowledge and health literacy. Thirty newly diagnosed prostate cancer patients from two Veteran's Administration (VA) hospitals in Chicago completed a demographic questionnaire and participated in an interactive CD-ROM shared decision making program. Subsequently, knowledge of prostate cancer, satisfaction with the information in the computer CD-ROM program, treatment preferences, and likelihood of following treatment preferences were assessed using interviewer-administered questionnaires. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The Pearson correlation test was used to assess the relationship between health literacy and prostate cancer knowledge. The chi2 test and the Fischer exact test were used to evaluate relationships between patient demographics and other variables. More than three-quarters of the patients rated the information in the CD-ROM as "very satisfactory" (highest possible rating). Two-thirds of the patients (21 of 30) selected a treatment after participation in the CD-ROM program and 90.5% of these patients stated that they were very or somewhat likely to adhere to their selection. However, prostate cancer knowledge was variable, with one-third of the patients scoring 69.9% or lower. Participants' health literacy was equivalent to a 7th-8th grade reading level (mean = 57.1+/-10.9), and more than one-third of participants (36.7%) had lower than 9th grade literacy levels. Participants' prostate cancer knowledge was correlated with health literacy (Pearson correlation rhor = 0.65, rhop = 0.0001). Patients were satisfied with the interactive shared decision making CD-ROM program, and two-thirds of patients were able to select a preferred treatment based on the information presented in the program that they intended to follow. However, prostate cancer knowledge scores varied among participants after participation in the CD-ROM program, raising doubts that patients were adequately informed to make appropriate choices regarding their treatment. Lower prostate cancer knowledge scores corresponded to lower literacy scores, indicating that low literacy may have hindered patient understanding of the shared decision making program. The development of shared decision making tools should include collaborative efforts with the target population to improve the success of shared decisio...

Education predicts quality of life among men with prostate cancer cared for in the department of Veterans affairs

“…One interpretation is that men with less education, even in an equal access to health care system, may experience greater difficulty understanding educational material on the disease, its treatments, and posttreatment care. 5 Poor understanding of the self-care instructions provided in the urology clinical setting or poor understanding of information on the kinds of posttreatment support available to manage symptoms may contribute to difficulties with the management of symptoms, worry about disease burden and recurrence, and difficulty in adjusting one's lifestyle to treatment schedules and symptoms. Interventional studies provide evidence consistent with this, suggesting that men with low education levels have a deficit of information that can be improved upon.…”

“…Whereas it is not clear that education level is related to prostate cancer outcomes, such as health-related quality of life (HRQOL), apart from its impact on the treatment choice, previous work has found that men with less education have less knowledge of prostate cancer before diagnosis 3,4 and have poor understanding of prostate cancer and its treatments after diagnosis even after participation in an educational program on prostate cancer. 5 Because poor understanding of prostate cancer and its treatment potentially could contribute to poor management of symptoms and greater disruption to lifestyle, it is important to understand the influence of education on HRQOL and on the specific symptoms associated with prostate cancer and its treatments.…”

Patient Decision Aids for Prostate Cancer Treatment: A Systematic Review of the Literature

“…The majority of the DAs were developed de novo; 2 trials used a DA developed by Holmes-Rovner et al 35,36 Kim et al used a DA produced by a pharmaceutical company. 37 Most DAs presented information in multiple formats, including written materials (8 trials) 30,31,[33][34][35][36][38][39][40] and multimedia presentations (8 trials), [35][36][37][38][40][41][42][43] and provided individualized information for patients based on their disease stage. Two trials tested interventions involving information exchange via in-person consultation with urologists and a multidisciplinary team.…”

“…[30][31][32][33][34][35][36][37][38][39][40][41][42][43] The DAs were delivered in 4 settings: hospitals (4 studies), physician's offices (1 study), patient education centers (4 studies), and nonmedical settings such as home or research office (4 studies). Participants were recruited from academic and community settings.…”

Associations between Quality of Life and Marital Status in Cancer Patients and Survivors

“…Previous studies focused only on QOL by socioeconomic status and the relationship between cancer and marital status (Goodwin et al, 1987;Burström et al, 2001;Kravdal, 2001), and some of these studies did not measure QOL using EQ-VAS or EQ-5D (Kim et al, 1999;Kobayashi et al, 2008). However, this study was cross-sectional in nature; hence, there are limitations in interpreting the causal relationship between QOL and marital status in patients with cancer and survivors of cancer.…”