Abstract
ObjectivePatient question‐asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question‐asking as a function of health literacy with respect to spoken information (health literacy–listening).MethodsFour‐hundred and thirty‐three (433) adults listened to simulated physician–patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy–listening was assessed using the Cancer Message Literacy Test‐Listening (CMLT‐Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT‐Listening asked a similar variety of questions.ResultsQuestions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT‐Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education.ConclusionPatients' health literacy–listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.
Highlights
Patient engagement, defined as patient involvement in actions needed to obtain the greatest benefit from available health-care services,[1] is a key component of patient-centred care and an important determinant of health status and outcomes.[2,3,4] Rather than passively receiving health-care prescriptions and recommendations, engaged patients make affirmative efforts to seek out health information and use that information to make decisions.[5]
Patients’ health literacy–listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling
We have proposed that the capacity to ask questions of physicians is a function of ‘interactive health literacy’, that is the kind of health literacy engaged patients enact when they talk with their providers.[15]
Summary
Patient engagement, defined as patient involvement in actions needed to obtain the greatest benefit from available health-care services,[1] is a key component of patient-centred care and an important determinant of health status and outcomes.[2,3,4] Rather than passively receiving health-care prescriptions and recommendations, engaged patients make affirmative efforts to seek out health information and use that information to make decisions.[5] Active involvement in discussions with physicians is one mark of patient engagement This element of engagement with one’s provider requires patients to exercise health literacy, which in turn is linked to positive health outcomes.[6,7]. Recent conceptualizations of health literacy continue to recognize the central role of oral processing,[10,11,12] and reviews of research linking health literacy to appropriate utilization of health services and positive health outcomes have decried the fact that most health literacy research has relied on assessments of print literacy only.[13,14]
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