TY - JOUR
T1 - Cancer risk communication with low health literacy patients
T2 - a continuing medical education program.
AU - Price-Haywood, Eboni G.
AU - Roth, Katherine G.
AU - Shelby, Kit
AU - Cooper, Lisa A.
N1 - Funding Information:
Dr. Price-Haywood is Robert Wood Johnson Foundation Harold Amos Faculty Development Program Scholar. The study sponsor has no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Price-Haywood and Katherine Roth had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Cooper is supported by a grant from the National Heart, Lung, and Blood Institute (K24HL083113). The authors wish to acknowledge Karen B DeSalvo, MD, MPH, MSc for providing a project coordinator for this study.
PY - 2010/5
Y1 - 2010/5
N2 - 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.
AB - 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.
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U2 - 10.1007/s11606-009-1211-6
DO - 10.1007/s11606-009-1211-6
M3 - Article
C2 - 20352506
AN - SCOPUS:78049511446
VL - 25 Suppl 2
SP - S126-129
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
ER -