Impact of numeracy on understanding of prostate cancer risk reduction in PSA screening

• Published in: PloS one 2017-12, Vol.12 (12), p.e0190357-e0190357
• Main Authors: Koo, Kevin, Brackett, Charles D, Eisenberg, Ellen H, Kieffer, Kelly A, Hyams, Elias S
• Format: Article
• Language: English
• Subjects: Analysis; Biology and Life Sciences; Cancer screening; Computer and Information Sciences; Genetic aspects; Health aspects; Medicine and Health Sciences; Prevention; Prostate cancer; Prostate specific antigen; Research and Analysis Methods; Social Sciences; Surveys
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0190357

Prostate-specific antigen (PSA) screening for prostate cancer in men of average risk remains controversial. Patients' ability to incorporate risk reduction data into their decision-making may depend on their numeracy. We assessed the impact of patients' numeracy on their understanding of the risk reduction benefits of PSA screening. Men attending a general internal medicine clinic were invited to complete a survey. Four versions of the survey each included a three-item numeracy test and PSA risk reduction data, framed one of four ways: absolute (ARR) versus relative risk reduction (RRR), with or without baseline risk (BR). Respondents were asked to adjust their perceived risk of prostate-cancer mortality using the data presented. Accuracy of risk reduction was evaluated relative to how risk data were framed. Among a total of 200 respondents, a majority incorrectly answered one or more of the numeracy items. Overall accuracy of risk adjustment was only 20%. Accuracy varied with data framing: when presented with RRR, respondents were 13% accurate without BR and 31% accurate with BR; when presented with ARR, they were 0% accurate without BR and 35% accurate with BR. Including BR data significantly improved accuracy for both RRR (P = 0.03) and ARR groups (P < 0.01). Accuracy was significantly related to numeracy; numeracy scores of 0, 1, 2, and 3 were associated with accuracy rates of six, five, nine, and 36 percent, respectively (P < 0.01). Overall, numeracy was significantly associated with the accuracy of interpreting quantitative benefits of PSA screening. Alternative methods of communicating risk may facilitate shared decision-making in the use of PSA screening for early detection of prostate cancer.