Low Literacy Intervention to Promote Discussion of Prostate Cancer

In an effort to reduce the incidence of prostate cancer, this intervention focuses on creating awareness via educational handouts. The handouts are distributed in the waiting rooms of primary care physicians in the hopes that patients are encouraged to discuss prostate cancer during their visit and are targeted to men, 45 years of age and older, without a history of prostate cancer and with a low level of literacy.

The low-literacy intervention took place between June and July of 2003, with funding in part by the CDC, the General Clinical Research Centers, and Emory University School of Medicine. Dr. Sunil Kripalani, a cohort of physicians and research staff, as well as Kirk Easley of Rollins School of Public Health, assisted with the intervention and data analysis. The primary intervention targeted men, aged 45 to 70, who lacked medical history of prostate cancer. During their visit to the primary care clinic at Grady Memorial Hospital, 250 men were randomly assigned one of three handouts: a highly-detailed handout written at the sixth-grade reading level (PtEd) that discussed the prostate gland, symptoms of prostate cancer, incidence of the disease, screening information, and suggestions to discuss options with a primary care giver; a low-detailed handout written at the fifth-grade reading level (Cue) discussing the location of the prostate gland and incidence of prostate cancer; and a handout of the traditional food pyramid with no direct information about prostate cancer, which served as the control.

After seeing their physician, patients were escorted into another room and interviewed by research staff. It was a single-blinded study, where the interviewer was unaware of which study group patients resided in. Patients were asked a series of questions about their dialogue with their physician—such as whether a PSA (blood test) was discussed—followed by a literacy test (all pamphlets were either of or below sixth grade reading level).

To educate men over the age of 45 about prostate cancer and to increase prostate cancer screening in order to reduce the incidence of prostate cancer.

The study found that although 48.4% of all patients discussed prostate cancer and screenings with their doctors, discussion varied greatly among the three study groups. Participants who received the Cue handout had 2.32 times the odds of discussing prostate cancer, compared to controls (OR: 2.32, 95% CI: 1.24-4.34). A more in-depth discussion of prostate cancer was observed among recipients of the PtEd handout, compared to controls although not significant (OR: 1.68, 95% CI: .91-3.10). In general, recipients of Cue and PtEd handouts were more likely to raise questions about prostate cancer, when compared to controls (40.0% Cue and 47.6% PtEd, vs. 9.7% controls) and there was not a significant difference between the Cue and PtEd groups. The findings of this study suggest that either form of the handout may improve engagement in healthcare of low-literacy patients. Finally, there was a six-fold increase in orders for postate cancer screening.