Login to Access Video or Poster Abstract: MP69-16
Sources of Funding: National Cancer Institute 5K12CA090625-14 (KM)

Introduction

A source of treatment regret and less engaged treatment decision making may be lack of health literacy and numeracy regarding terms commonly associated with prostate cancer treatment. The objective of this study was to determine community levels of health literacy and numeracy and their association with terminology commonly used when discussing prostate cancer treatment.

Methods

A total of 52 men from the outpatient clinics of Nashville General Hospital (n=41), which primarily serves the uninsured, Medicaid/Medicare, and indigent populations in the greater Nashville area, and Vanderbilt University Medical Center (n=11) participated. Demographic information was collected, and health literacy and numeracy were assessed using the revised Rapid Estimate of Adult Literacy in Medicine (REALM-R), the Brief Health Literacy Screen (BHLS), the Subjective Numeracy Scale (SNS-3), and Schwartz-Woloshin (S-W) questionnaires. Men were asked to identify the location of the prostate on a standardized model of the male pelvis. They were then asked to complete a 29-term questionnaire which asks men to define terms associated with sexual, bowel and urinary function. Adequate health literacy (AHL) was defined as a REALM-R score >=6, and inadequate health literacy (IHL) was REALM-R <6.

Results

Median age of the cohort was 55y, 57.7% were Black, 75% had annual household income <$20,000, and 28.8% had less than 12th grade education. Median REALM-R score was 8 (IQR 2-8), median BHLS score was 11 (IQR 9-14.25), median SNS-3 score was 11 (IQR 8-14), and median S-W score was 1 (IQR 1-2). Overall, 40.4% of men were able to identify the location of the prostate. For the 29-item questionnaire, the median number of correct responses was 23.5. Men with AHL had significantly higher percent of correct responses compared to men with IHL (89.5% vs 54.5%, p<0.005). There was a significant, positive linear relationship with amount of formal education and total correct responses (p=0.002). Men with annual incomes <$20,000 had significantly lower correct scores (19.5 vs 25.3 for >$20,000, p <0.02). Each of the measures of health literacy and numeracy were strongly related to understanding of the functional terms (Spearman correlation REALM-R r=0.72, BHLS r=0.72, SNS-3 r=0.62; all p<0.001).

Conclusions

The rates of low health literacy and numeracy are high and are associated with lack of knowledge of prostate cancer related terminology. Efforts to improve effective communication regardless of patient health literacy level are needed.

Funding

National Cancer Institute 5K12CA090625-14 (KM)