Faculty Collaboration Database

Improving Communication in Breast Cancer Treatment Consultation: Use of a Computer Test of Health Numeracy. J Womens Health (Larchmt) 2019 Oct;28(10):1407-1417

Date

06/27/2019

Pubmed ID

31237471

Pubmed Central ID

PMC6797073

DOI

10.1089/jwh.2018.7347

Scopus ID

2-s2.0-85073582949 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Background: Communication of statistics and probability is challenging in the cancer care setting. The objectives of this study are to evaluate a novel approach to cancer communication through the use of a computer assessment of patient health numeracy. Methods: We conducted a pilot study of the Computer Adapted Test of Numeracy Understanding in Medicine Instrument (CAT-NUMi) before the cancer treatment consultation for women with stage 0-3 breast cancer. Patient outcomes included the interpersonal processes of care (IPC) and the decisional conflict scale. We evaluated clinician use of numeric information in the cancer consultation and assessed feasibility outcomes from the clinician and patient perspective. Results: Patient participants (n = 50) had a median (interquartile range) age of 51 years (46-61), 70% were English speaking, and 30% Spanish speaking. Decisional conflict was low with a mean (standard deviation [SD]) decisional conflict score of 17.4 (12.3). The lack of clarity score (range 1-5) on the IPC was low (mean, SD),1.70 (0.71), indicating clear communication. Clinicians more often used percentages in communicating prognosis among those with higher numeracy scores (median, range): high (2, 0-8), medium (1, 0-7), and low (0, 0-8); p = 0.04. The patient experience of taking the CAT-NUMi was rated as very good or excellent by 65%, fair by 33%, and poor by 2% of patients. Conclusion: Screening for health numeracy with a short computer-based test may be a feasible strategy to optimize clear communication in the cancer treatment consultation. Further studies are needed to evaluate this strategy across cancer treatment clinical settings and populations.

Author List

Schapira MM, Fletcher KE, Ganschow PS, Jacobs EA, Walker CM, Smallwood AJ, Gil D, Faghri A, Kong AL, Yen TW, McDunn S, Marcus E, Neuner JM

Authors

Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of Wisconsin
Amanda L. Kong MD, MS Professor in the Surgery department at Medical College of Wisconsin
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Breast Neoplasms
Cohort Studies
Communication
Computers
Feasibility Studies
Female
Health Knowledge, Attitudes, Practice
Health Literacy
Humans
Middle Aged
Patient Participation
Physician-Patient Relations
Pilot Projects
Prospective Studies
Referral and Consultation
Surveys and Questionnaires