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Randomized Controlled Trial
. 2007 Aug;33(2):83-90.
doi: 10.1016/j.amepre.2007.03.018.

Low-literacy interventions to promote discussion of prostate cancer: a randomized controlled trial

Sunil Kripalani  1 , Jyoti Sharma, Elizabeth Justice, Jeb Justice, Cynthia Spiker, Larry E Laufman, Megan Price, Armin D Weinberg, Terry A Jacobson
Affiliations
Randomized Controlled Trial

Low-literacy interventions to promote discussion of prostate cancer: a randomized controlled trial

Sunil Kripalani et al. Am J Prev Med. 2007 Aug.

Erratum in

  • Am J Prev Med. 2008 Mar;34(3):270. Jacobson, Terry A [added]

Abstract

Background: Professional organizations recommend that physicians discuss prostate cancer with patients to make individual screening decisions. However, few studies have tested strategies to encourage such discussions, particularly among high-risk populations. We examined the effects of two low-literacy interventions on the frequency of prostate cancer discussion and screening.

Design: Randomized, blinded, controlled trial with concealed allocation.

Setting/participants: Inner-city primary care clinic, serving a predominately African-American population. Participants were men aged 45-70 with no history of prostate cancer, presenting for a regular appointment.

Interventions: While waiting to see their physician, patients received a patient education handout on prostate cancer screening (PtEd), a handout simply encouraging patients to talk to their doctor about prostate cancer (Cue), or a control handout. The interventions did not advocate for or against screening.

Measures: Patient-reported discussion of prostate cancer with the physician and chart reviews determine prostate-specific antigen (PSA) test orders and performance of digital rectal examination (DRE). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were computed. Data were collected in 2003, and analyses were completed in 2006.

Results: Most of the 250 subjects (90.4%) were African American and 78.8% read below the ninth grade level. Overall, 48.4% reported discussing prostate cancer during the appointment. Compared to the control group (37.3%), discussions were significantly more common in the Cue group (58.0%, aOR=2.39 [1.26-4.52]), as well as in the PtEd group (50.0%, aOR=1.92 [1.01-3.65]). When prostate cancer was discussed, patients in the intervention groups more commonly initiated the conversation (47.6% PtEd and 40.0% Cue, vs 9.7% control, p<0.01 for each comparison to control). Compared to the control group (2.4%), PSA test orders increased in the PtEd group (14.1%, aOR=7.62 [1.62-35.83]) and in the Cue group (12.3%, aOR=5.86 [1.24-27.81]). Documentation of DRE did not change significantly (4.7% PtEd, 6.2% Cue, and 6.0% control).

Conclusions: Two simple low-literacy interventions significantly increased discussion of prostate cancer and PSA test orders but not performance of DRE. Both interventions were effective in empowering low-literacy patients to initiate conversations about prostate cancer with their physician.

Trial registration: ClinicalTrials.gov NCT00208988.

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Conflict of interest statement

No financial conflict of interest was reported by the authors of this paper.

Figures

Figure 1
Figure 1
Patient education handout (PtEd) © Sunil Kripalani, MD, MSc, Cynthia Spiker, MPH, and Baylor College of Medicine, 2007. Reprinted with permission.
Figure 1
Figure 1
Patient education handout (PtEd) © Sunil Kripalani, MD, MSc, Cynthia Spiker, MPH, and Baylor College of Medicine, 2007. Reprinted with permission.
Figure 2
Figure 2
Talk to doctor handout (Cue) © Sunil Kripalani, MD, MSc, Cynthia Spiker, MPH, and Baylor College of Medicine, 2007
Figure 3
Figure 3
Study flow diagram * Numbers are approximate because the exact number of men who were excluded was not tracked. ** Treatment assignment not recorded PtEd = Patient education handout, Cue = Talk to doctor handout, Control = Food pyramid
See this image and copyright information in PMC

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