Low literacy hinders prostate cancer discussions

Clinicians should speak colloquially when discussing prostate cancer with low-income men, because most of them don't understand the most basic medical terms, a new study advises.

A team of researchers led by Kerry L. Kilbridge, MD, of  Massachusetts General Hospital in Boston interviewed 105 men at two low-income clinics. They found fewer than half understood the terms erection or impotent. Only 5% understood incontinence (J Clin Oncol. 2009;27;2015-2021).

Patients tended to recognize roots but not related terms. For example, 70% understood urine and 79% understood urination, but the majority did not understand the terms urinary frequency or urinary function.

“Many commonly used medical terms were completely unknown to a large proportion of patients,” the authors observe. Even if educational materials, consent forms, or quality of life questions were read aloud to overcome literacy barriers, they may still be misunderstood. Clinicians may be misled about their patients' symptoms and outcomes as a result.

The patients in the study ranged from age 40 to 89 years (average age 58 years), and 91% identified themselves as black. Two-thirds of the group had not completed high school. Fewer than half read above sixth-grade level, and 27% were illiterate or read at third-grade level or below.

A table of synonymous terms and a colloquial explanation of the digital rectal exam are available online at jco.ascopubs.org/cgi/content/full/27/12/2015 (subscription required).

Low health literacy is probably not limited to prostate cancer. For example, the cohort in a recent longitudinal neighborhood study in Manhattan had a mean education level of 6.6 years. (Arch Neurol. 2009;66:343-348).

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