Health literacy and shared decision making for prostate cancer patients with low socioeconomic status
Health literacy and shared decision making for prostate cancer patients with low socioeconomic status
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DOI：
10.1081/cnv-100106143
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发表时间：
2001-01-01
影响因子：
2.4
通讯作者：
Bennett, CL
中科院分区：
文献类型：
--
作者：
Kim, SP;Knight, SJ;Bennett, CL
生活质量（QOL）的考虑是重要的治疗决策过程中的前列腺癌患者。虽然鼓励患者参与治疗决策过程，但健康素养低可能会限制患者对治疗及其可能的QOL结果的复杂信息的理解，并且是患者参与决策过程的障碍。本研究的目的是评估（i）参与CD-ROM共享决策程序后新诊断为前列腺癌的男性的知识，满意度，治疗偏好和意图;以及（ii）前列腺癌知识和健康素养之间的关系。来自芝加哥两家退伍军人管理局（VA）医院的30名新诊断的前列腺癌患者完成了人口统计学调查问卷，并参加了交互式CD-ROM共享决策程序。随后，前列腺癌的知识，满意度的信息在计算机光盘程序，治疗偏好，和可能性以下的治疗偏好进行了评估，使用访谈管理的问卷。健康素养评估使用成人医学素养快速评估（REALM）。Pearson相关性检验用于评估健康素养与前列腺癌知识之间的关系。使用卡方检验和Fischer精确检验来评估患者人口统计数据与其他变量之间的关系。超过四分之三的患者将CD-ROM中的信息评为“非常满意“（可能的最高评级）。三分之二的患者（21/30）在参与CD-ROM计划后选择了治疗，其中90.5%的患者表示他们非常有可能或在一定程度上坚持他们的选择。然而，前列腺癌知识是可变的，三分之一的患者得分为69.9%或更低。参与者的健康素养相当于7 - 8年级的阅读水平（平均值= 57.1 +/- 10.9），超过三分之一的参与者（36.7%）的素养水平低于9年级。参与者的前列腺癌知识与健康素养相关（Pearson相关系数rhor = 0.65，rhp 0.0001）。患者对交互式共享决策CDROM程序感到满意，三分之二的患者能够根据他们打算遵循的程序中提供的信息选择首选治疗。然而，前列腺癌的知识得分不同的参与者，在参加CD-ROM程序后，提出了怀疑，患者充分知情，使他们的治疗作出适当的选择。较低的前列腺癌知识得分对应于较低的识字率得分，表明低识字率可能阻碍了患者对共享决策程序的理解。共享决策工具的开发应包括与目标人群的合作，以提高健康素养低的患者共享决策计划的成功率。
Quality, of life (QOL) considerations are important in the treatment decision making process for prostate cancer patients. Although patient involvement in the treatment decision process has been encouraged, low health literacy can limit patient understanding of the complex information about treatments and their probable QOL outcomes and is a barrier to patient participation in the decision-making process. The objectives of the study were to evaluate (i) knowledge, level of satisfaction, and treatment preferences and intentions of men newly diagnosed with prostate cancer after participation in a CD-ROM shared decision making program; and (ii) the relationship between prostate cancer knowledge and health literacy. Thirty newly diagnosed prostate cancer patients from two Veteran's Administration (VA) hospitals in Chicago completed a demographic questionnaire and participated in an interactive CD-ROM shared decision making program. Subsequently, knowledge of prostate cancer, satisfaction with the information in the computer CD-ROM program, treatment preferences, and likelihood of following treatment preferences were assessed using interviewer-administered questionnaires. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The Pearson correlation test was used to assess the relationship between health literacy and prostate cancer knowledge. The chi (2) test and the Fischer exact test were used to evaluate relationships between patient demographics and other variables. More than three-quarters of the patients rated the information in the CD-ROM as "very satisfactory " (highest possible rating). Two-thirds of the patients (21 of 30) selected a treatment after participation in the CD-ROM program and 90.5% of these patients stated that they were very or somewhat likely to adhere to their selection. However, prostate cancer knowledge was variable, with one-third of the patients scoring 69.9% or lower. Participants' health literacy was equivalent to a 7th-8th grade reading level (mean = 57.1 +/- 10.9), and more than one-third of participants (36.7%) had lower than 9th grade literacy levels. Participants' prostate cancer knowledge was correlated with health literacy (Pearson correlation rhor = 0.65, rhop 0.0001). Patients were satisfied with the interactive shared decision making CDROM program, and two-thirds of patients were able to select a preferred treatment based on the information presented in the program that they intended to follow. However, prostate cancer knowledge scores varied among participants, after participation in the CD-ROM program, raising doubts that patients were adequately informed to make appropriate choices regarding their treatment. Lower prostate cancer knowledge scores corresponded to lower literacy scores, indicating that low literacy may have hindered patient understanding of the shared decision making program. The development of shared decision making tools should include collaborative efforts with the target population to improve the success of shared decision making programs among patients with low health literacy.