Cancer risk communication with low health literacy patients: a continuing medical education program.

BACKGROUND: Low health literacy (HL) is an important risk factor for cancer health disparities. OBJECTIVE: Describe a continuing medical education (CME) program to teach primary care physicians (PCP) cancer risk communication and shared decision-making (SDM) with low HL patients and baseline skills assessment. DESIGN: Cluster randomized controlled trial in five primary care clinics in New Orleans, LA. PARTICIPANTS: Eighteen PCPs and 73 low HL patients overdue for cancer screening. INTERVENTION: Primary care physicians completed unannounced standardized patient (SP) encounters at baseline. Intervention physicians received SP verbal feedback; academic detailing to review cancer screening guidelines, red flags for identifying low HL, and strategies for effective counseling; and web-based tutorial of SP comments and checklist items hyperlinked to reference articles/websites. MAIN MEASURES: Baseline PCP self-rated proficiency, SP ratings of physician general cancer risk communication and SDM skills, patient perceived involvement in care. RESULTS: Baseline assessments show physicians rated their proficiency in discussing cancer risks and eliciting patient preference for treatment/decision-making as "very good". SPs rated physician exploration of perceived cancer susceptibility, screening barriers/motivators, checking understanding, explaining screening options and associated risks/benefits, and eliciting preferences for screening as "satisfactory". Clinic patients rated their doctor's facilitation of involvement in care and information exchange as "good". However, they rated their participation in decision-making as "poor". DISCUSSION: The baseline skills assessment suggests a need for physician training in cancer risk communication and shared decision making for patients with low HL. We are determining the effectiveness of teaching methods, required resources and long-term feasibility for a CME program.