Abstract A11: Health information needs and predictors of cancer screening status among patients with limited health literacy

Abstract

Abstract Background: Primary care physician (PCP) recommendation for cancer screening is a strong predictor of adherence to screening; however, patients with limited health literacy (HL) may have difficulty understanding information about screening. We implemented a continuing medical education program to train PCPs in cancer risk communication with limited HL patients. Our main study objective is to determine whether changes in PCP communication improve patients’ adherence to cancer screening. We examined baseline patient characteristics to assess whether patients’ cancer screening information needs vary across levels of limited HL and determine which factors may influence adherence to different types of cancer screening tests. Methods: This study is part of a 4-year randomized controlled trial of a communication skills training program targeting PCPs (11 intervention vs. 8 control) who practice in safety-net clinics in New Orleans, LA and their patients with limited HL (Rapid Estimate of Adult Literacy in Medicine [REALM] score < 60). For each PCP, we recruited 10 patients (men [age 50–75]; women [age 40–75]) who were overdue for at least one cancer screening test (mammography; pap smears; FOBT/ endoscopy/barium enema). We conducted baseline interviews to obtain socio-demographics, cancer knowledge, cancer screening status and ratings of physician communication style (Perceived Involvement in Care Scale). We conducted baseline chart reviews to confirm cancer screening status. Results: Of 871 clinic patients screened to date, 164 met eligibility criteria (target sample size: 180). The most common reasons for exclusion were HL too high (37%), up-to-date on cancer screening (20%), or new patients to the PCP (12%). Most eligible patients are African American (90%), female (77%), insured (61%) and read at the 7th-8th grade level (67%). Only 35% of the study sample was up-to-date by chart review on mammography, 34% on pap smears, and 29% on colorectal cancer screening. Patient ratings of the level of information exchange with their PCPs varied by level of HL with patients with < 3rd grade reading level rating their PCPs significantly lower (mean [SD]: 2.9 [1.4]) than patients with higher reading levels (7th-8th grade: 3.4 [1.0]; 5th-6th grade: 3.7 [0.6]). Overall, less than 1/3 of patients knew the age at which to start breast/cervical/CRC screening. Knowledge about the cancer screened for by mammography and the tests available for CRC screening varied significantly by level of HL (7th-8th grade vs. 5th-6th grade vs. <3rd grade: Breast, 83% vs. 69% vs. 41%; CRC, 51% vs. 32% vs. 12%). Only 10% of patients knew that pap smears screen for cervical cancer. There was no significant difference in cancer screening status by level of HL, cancer screening knowledge or perceptions of involvement in care. For mammography, the odds of being up-to-date increased with having insurance (OR, 95% CI: 3.2 [1.4–7.5]) and emotional/informational support (1.6 [1.2-2.2]) whereas receiving care in a community health center reduced the odds (0.42 [0.2-0.9]). For CRC screening, family history of CRC increased the odds of being up-to-date (5.7 [1.3-23.8]) whereas emotional/informational support reduced the odds (0.63 [0.5-0.9]). There were no significant factors that influenced cervical cancer screening status. Although patients’ perceptions of health information exchange and cancer screening knowledge may depend on their level of health literacy, psychosocial, familial and health system related factors may ultimately influence adherence to cancer screening. Message framing for cancer risk communication should take these factors into consideration. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A11.