Low-literacy interventions to promote discussion of prostate cancer: a randomized controlled trial

• Published in: American journal of preventive medicine 2007-08, Vol.33 (2), p.83-90
• Main Authors: Kripalani, Sunil, Sharma, Jyoti, Justice, Elizabeth, Justice, Jeb, Spiker, Cynthia, Laufman, Larry E, Price, Megan, Weinberg, Armin D, Jacobson, Terry A
• Format: Article
• Language: English
• Subjects: African Americans; Aged; Black American people; Communication; Doctor-Patient communication; Educational Status; Health Education; Humans; Literacy; Male; Mass Screening; Middle Aged; Patient Education as Topic; Pilot Projects; Preventive Medicine; Prostate-Specific Antigen; Prostatic cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - prevention & control; Risk Factors; Screening; United States
• ISSN: 0749-3797
• DOI: 10.1016/j.amepre.2007.03.018

Professional organizations recommend that physicians discuss prostate cancer with patients to make individual screening decisions. However, few studies have tested strategies to encourage such discussions, particularly among high-risk populations. We examined the effects of two low-literacy interventions on the frequency of prostate cancer discussion and screening. Randomized, blinded, controlled trial with concealed allocation. Inner-city primary care clinic, serving a predominately African-American population. Participants were men aged 45-70 with no history of prostate cancer, presenting for a regular appointment. While waiting to see their physician, patients received a patient education handout on prostate cancer screening (PtEd), a handout simply encouraging patients to talk to their doctor about prostate cancer (Cue), or a control handout. The interventions did not advocate for or against screening. Patient-reported discussion of prostate cancer with the physician and chart reviews determine prostate-specific antigen (PSA) test orders and performance of digital rectal examination (DRE). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were computed. Data were collected in 2003, and analyses were completed in 2006. Most of the 250 subjects (90.4%) were African American and 78.8% read below the ninth grade level. Overall, 48.4% reported discussing prostate cancer during the appointment. Compared to the control group (37.3%), discussions were significantly more common in the Cue group (58.0%, aOR=2.39 [1.26-4.52]), as well as in the PtEd group (50.0%, aOR=1.92 [1.01-3.65]). When prostate cancer was discussed, patients in the intervention groups more commonly initiated the conversation (47.6% PtEd and 40.0% Cue, vs 9.7% control, p