Low literacy interventions to promote discussion of prostate cancer - A randomized controlled trial
Low literacy interventions to promote discussion of prostate cancer - A randomized controlled trial
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DOI：
10.1016/j.amepre.2007.03.018
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发表时间：
2007-08-01
影响因子：
5.5
通讯作者：
Weinberg, Armin D.
中科院分区：
文献类型：
--
作者：
Kripalani, Sunil;Sharma, Jyoti;Weinberg, Armin D.
背景：专业组织建议医生与患者讨论前列腺癌以做出个体筛查决定。然而，很少有研究测试了鼓励这种讨论的策略，特别是在高风险人群中。我们研究了两种低文化干预对前列腺癌讨论和筛查频率的影响。设计：随机、盲法、隐蔽分配的对照试验。环境/参与者：市中心初级保健诊所，主要服务于非裔美国人。参与者年龄在45-70岁之间，没有前列腺癌病史，定期就诊。干预：在等待看医生的过程中，患者收到了一份关于前列腺癌筛查（PtEd）的患者教育讲义，一份只是鼓励患者与他们的医生谈论前列腺癌（Cue）的讲义，或者一份对照讲义。这些干预措施并没有提倡或反对筛查。措施：患者报告的前列腺癌与医生的讨论和图表回顾确定前列腺特异性抗原（PSA）测试顺序和直肠指检（DRE）的表现。计算校正优势比（aOR）和95%置信区间（CI）。数据于2003年收集，分析于2006年完成。结果：250名被试中大部分是非裔美国人（90.4%），78.8%的人阅读水平低于九年级。总体而言，48.4%的人报告在预约期间讨论了前列腺癌。与对照组（37.3%）相比，Cue组（58.0%,aOR=2.39[1.26-4.52]）和PtEd组（50.0%,aOR=1.92[1.01-3.65]）的讨论明显更常见。当讨论前列腺癌时，干预组患者更常主动交谈（47.6%的PtEd和40.0%的Cue，对比9.7%的对照组，p < 0.01）。与对照组（2.4%）相比，PtEd组（14.1%,aOR=7.62[1.62-35.83]）和Cue组（12.3%,aOR=5.86[1.24-27.81]）的PSA检测次数增加。DRE的记录没有显著变化（PtEd 4.7%, Cue 6.2%, control 6.0%）。结论：两种简单的低文化干预措施显著增加了前列腺癌和PSA检查顺序的讨论，但没有提高DRE的表现。这两种干预措施都能有效地让低文化水平的患者主动与医生讨论前列腺癌。
Background: 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.Design: Randomized, blinded, controlled trial with concealed allocation.Setting/Participants: 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.Interventions: 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.Measures: 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.Results: 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 < 0.01 for each comparison to control). Compared to the control group (2.4%), PSA test orders increased in the PtEd group (14.1%, aOR=7.62 [1.62-35.83]) and in the Cue group (12.3%, aOR=5.86 [1.24-27.81]). Documentation of DRE did not change significantly (4.7% PtEd, 6.2% Cue, and 6.0% control).Conclusions: Two simple low-literacy interventions significantly increased discussion of prostate cancer and PSA test orders but not performance of DRE. Both interventions were effective in empowering low-literacy patients to initiate conversations about prostate cancer with their physician.