Severe lack of comprehension of common prostate health terms among low‐income inner‐city men

Abstract

BACKGROUND: Patients diagnosed with prostate cancer are often counseled about treatment options with the use of terms that are part of the "core vocabulary" of prostate cancer. It is hypothesized that predominantly lower literacy patients would demonstrate a severe lack of comprehension of prostate cancer terms, thus validating the findings of a previous single-institution study. METHODS: A previously developed survey was used to evaluate understanding of terms related to urinary, bowel, and sexual function. The survey was administered by trained evaluators at 2 safety net clinics that provide care for low-income, predominantly African American patients. Comprehension was assessed using semiqualitative methods coded by 2 independent investigators. Literacy and numeracy were also evaluated. RESULTS: Among 109 patients who completed the study, only 5% understood the function of the prostate, and 15%, 29%, and 32% understood the terms "incontinence," "urinary function," and "bowel habits," respectively. Lower levels of comprehension were observed for compound words, such as "vaginal intercourse" (58%), versus single words such as "intercourse" (95%), validating previous work. Median school level was 13 years, yet median literacy level was only ninth grade, and reading level was significantly correlated with comprehension. Only 30% of patients correctly calculated both a fraction and a percent. CONCLUSIONS: Lack of comprehension of prostate health terminology is pronounced in this patient population and may be widespread. This lack of comprehension potentially limits the ability of patients to participate in informed decision-making. These results validate the findings of previous studies and support a continued need for refined methods of prostate cancer education. Cancer 2013;119:3204-11.

Income inequality and treatment of African American men with high-risk prostate cancer

“…Recent work demonstrates significant lack of comprehension of common prostate cancer terms [28] and barriers to shared decision making [29] among economically disadvantaged men. Poor communication between patients and providers regarding the efficacy and adverse effects of treatment likely encourages decisional regret among some AA men [30] and contributes to the prevalence of shared perspectives for or against certain health care interventions within communities.…”

What Is a “Good” Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer

“…26, 54 In samples including larger proportions of less educated men, greater variance in knowledge should result in greater variation in decision-making experiences.…”

Empirical relationships between health literacy and treatment decision making: A scoping review of the literature

“…Third, some measures of HL were used in an inconsistent manner across studies, making comparisons of the findings difficult. For example, the original four categories of the REALM (i.e., 0-3 rd grade, 4 th -6 th grade, 7 th -8 th grade, 9 th grade and above) were used in some studies [22,33,34,35,36,37], but were reduced to three [38,39,40,41] or two [14,15,42,43,44,45,46,47] in others -with some loss of information and thus implications for the validity of the findings. In two studies, the REALM was treated as a continuous variable [16,48].…”

“…Ten studies examined empirical relationships between assessments of patients' HL and patients' understanding of information [9,14,15,17,19,23,33,35,50,51]. Across these studies, patients' understanding was variously defined and measured by researchers and the findings were also variable.…”