Health literacy and shared decision making for prostate cancer patients with low socioeconomic status

Quality, of life (QOL) considerations are important in the treatment decisi on making process for prostate cancer patients. Although patient involvemen t in the treatment decision process has been encouraged, low health literac y can limit patient understanding of the complex information about treatmen ts and their probable QOL outcomes and is a barrier to patient participatio n in the decision-making process. The objectives of the study were to evalu ate (i) knowledge, level of satisfaction, and treatment preferences and int entions 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 prost ate cancer patients from two Veteran's Administration (VA) hospitals in Chi cago completed a demographic questionnaire and participated in an interacti ve CD-ROM shared decision making program. Subsequently, knowledge of prosta te 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 literac y was assessed using the Rapid Estimate of Adult Literacy in Medicine (REAL M). The Pearson correlation test was used to assess the relationship betwee n health literacy and prostate cancer knowledge. The chi (2) test and the F ischer exact test were used to evaluate relationships between patient demog raphics and other variables. More than three-quarters of the patients rated the information in the CD-ROM as "very satisfactory " (highest possible ra ting). Two-thirds of the patients (21 of 30) selected a treatment after par ticipation in the CD-ROM program and 90.5% of these patients stated that th ey were very or somewhat likely to adhere to their selection. However, pros tate cancer knowledge was variable, with one-third of the patients scoring 69.9% or lower. Participants' health literacy was equivalent to a 7th-8th g rade reading level (mean = 57.1 +/- 10.9), and more than one-third of parti cipants (36.7%) had lower than 9th grade literacy levels. Participants' pro state cancer knowledge was correlated with health literacy (Pearson correla tion rhor = 0.65, rhop 0.0001). Patients were satisfied with the interactiv e shared decision making CDROM program, and two-thirds of patients were abl e to select a preferred treatment based on the information presented in the program that they intended to follow. However, prostate cancer knowledge s cores 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 c orresponded 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 ef forts with the target population to improve the success of shared decision making programs among patients with low health literacy.