Using Effective Provider-Patient Communication to Improve Cancer Screening Among Low Literacy Patients
Condition: Cervical Cancer; Breast Cancer; Colorectal Cancer
MeSH terms: Colorectal Neoplasms; Uterine Cervical Neoplasms
Study type: Interventional

Summary: 
      What's the purpose of this study? This 4-year study is designed: (1) to teach primary care
      physicians how to recognize low health literacy patients and effectively counsel them on
      cancer screening using risk communication and shared decision making and (2) to assess the
      impact of training on changes in physician communication behavior and changes in low health
      literacy patients' cancer screening behaviors. This study proposal is based on the hypothesis
      that physician training in cancer screening guidelines, health literacy, and communication
      skills will improve provider-patient interactions during encounters dealing with preventive
      health maintenance especially cancer screening.

      How will the proposed study be implemented? Thirty-two physicians in the New Orleans
      metropolitan area will be recruited and randomly assigned to one of two groups. The unit of
      randomization will be the health care organization or clinic. The intervention group will
      receive training in health literacy, cancer screening, risk communication and shared
      decision-making. The control group will not receive communication training until the end of
      the study. Physicians in both groups will undergo three clinic visits with standardized
      patients (actors trained to portray real patients; mystery shoppers) but they will not be
      aware that they are conducting visits with actors. The visits will occur at study enrollment
      and at 6 and 12 months. At the end of each clinic visit, the standardized patients will rate
      the physicians' communication skills. Each physician assigned to the intervention group will
      receive verbal feedback on communication skills from the standardized patients and complete a
      web-based tutorial. Physicians in the control group will not have access to the web-based
      tutorial until the end of the study.

      For each physician, 10-15 patients with limited health literacy will be recruited to the
      study. Each patient will rate his/her perceived involvement with care and global satisfaction
      with care at study enrollment and annually for three years. Age and gender-appropriate
      referral rates for breast, cervical and colorectal cancer screening and patients' receipt of
      such screening will be assessed annually for three years. All study physicians, regardless of
      group assignment, will receive performance feedback (report cards) on their cancer screening
      rates among low health literacy patients in their clinic.
    


Intervention name(s): Cancer risk communication skills training
Intervention type(s): Other
Intervention description(s): Intervention physicians receive training in cancer risk communication and shared decision making (SDM). At the end of each visit with intervention physicians, standardized patients (SPs) reveal themselves as actors and give structured verbal feedback. After baseline SP visits, each intervention physician undergoes academic detailing with a communication expert. Intervention physicians are directed to a web-based communication skills tutorial where SP ratings are hyperlinked to key references for supplemental reading. Both study groups will receive annual reports detailing their patients' cancer screening status and aggregate ratings of their communication style.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: health literacy; cancer screening; doctor-patient communication; standardized patient; continuing medical education