- Clinicians must use stronger patient education strategies to help increase health literacy in cancer patients, according to a study published in the Journal of the American Board of Family Medicine.
Treatment decisions for certain types of cancers, such as localized prostate cancer (LPC), are often very difficult because the two common treatment options yield similar survival rates. Radiation therapies and surgical treatments, although having different side effects for different patients, present tough choices for patients and providers to make.
Many LPC clinicians practice shared decision-making with their patients to choose the right treatment for the individual case. However, shared decision-making requires high baseline patient health literacy that currently many patients do not have.
A self-administered survey about health literacy and decision-making among about 200 men confirmed that LPC knowledge is low, the research team reported.
The mean LPC knowledge score was 5.87 out of a possible 11 points. Over one-third of men who received radiation or surgical treatments did not know the long-term impacts of their treatments, and fewer than half of the respondents correctly answered questions about treatment side effects.
However, these knowledge shortcomings did not adversely impact the decision-making process. The research team observed no correlation between health literacy and treatment choice, nor any correlation between health literacy and decision regret.
In fact, the research team observed a positive correlation between decision-making difficulty and high knowledge level. Decision-making difficulty was defined as the anxious, distressing, and uncertain feelings patients experience during the share decision-making process, the researchers explained. When patients had a higher health literacy score, they experienced a higher rate of decision difficulty.
“We think this result is plausible since so many controversies and uncertainties exist surrounding the myriad treatment options for LPC and a lack of consensus even among experts regarding the best decision,” the researchers posited.
“Another possible explanation is that when men's overall knowledge of treatment side effects and survival benefit is so low, it may not reach the threshold at which a positive impact on decision-making difficulty can be observed,” the team added.
An inadvertent but important finding to the surveys was the knowledge gaps that emerged among various patient populations. Patients who are black, single, or with low educational attainment on average scored lower on the health literacy assessment than other patient populations. These findings presented an opportunity for clinicians to support high-risk patients better during the treatment process.
For example, all patients regardless of demographic reported that it was difficult to obtain their own informational sources. Clinicians should support all patients, but especially these vulnerable populations, in obtaining that information.
“Increased accessibility to comprehensive and accurate, unbiased information about prostate cancer beyond health care providers may improve men's knowledge before making this important and difficult treatment decision,” the researchers recommended. “This may provide a basis for them to make informed treatment decisions that are concordant with their treatment goals and preferences, provided they get adequate support from their physicians.”
Clinicians should also work on being better informational resources themselves.
“PCPs were found to be the second most commonly used source for prostate cancer knowledge, after urologists,” the team said. “This suggests opportunities for PCPs to provide unbiased information during the critical treatment decision-making time, as the literature suggests that specialists are more likely to be biased toward whatever options they deliver themselves.”
While health literacy had little impact on the decision-making process, the research team maintained that ramping up patient education efforts will nonetheless be beneficial for LPC patients. The limited impact health literacy had on decision-making may be because patient literacy was so low, the team said, and closing that gap could have eventual impacts on share decision-making.
“These findings underscore the importance and necessity of better patient education to increase knowledge of LPC, but it may not alleviate men's decision-making difficulty because of the current scientific uncertainty in this area,” the research team concluded.