Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, Atlanta, GA, USA.
Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Qual Life Res. 2019 Jul;28(7):1793-1801. doi: 10.1007/s11136-019-02109-9. Epub 2019 Jan 17.
Age is often used to determine when children can begin completing patient-reported outcome (PRO) instruments or transition to adult instruments. This study's purpose was to determine relationships between literacy, age, and race and their influence on a child's ability to understand and complete a PRO instrument.
The Wide Range Achievement Test was used to evaluate literacy in children and young adults with cancer, participating in a cognitive interview for the Pediatric PRO-CTCAE instrument. 140 participants (7-20 years) were recruited from 8 sites. Logistic regression and multivariable liner regression were used to examine relationships among key variables.
Higher literacy scores were significantly associated with fewer PRO-CTCAE items being identified as "hard to understand" (p = 0.017). Literacy scores increased with age, but older participants were more likely to fall behind expected reading levels compared with US norms. A 1-year increase in age was associated with a 19% increase in the likelihood for being below the expected WRAT word reading score (OR 1.19; 95% CI 1.06-1.33, p = 0.003). No associations were found between race and literacy.
Wide variations in literacy were noted across age groups. All participants were able to complete the Pediatric PRO-CTCAE, although most 7 year olds (63%) required reading assistance. Those with lower literacy skills were able to understand items suggesting that multiple factors may be involved in comprehension (developmental stage, concentration, vocabulary, or prior health experiences). Risk for falling below expected literacy levels increased with age implying a need for literacy consideration for cancer patients.
年龄通常用于确定儿童何时可以开始完成患者报告的结局（PRO）工具或过渡到成人工具。本研究的目的是确定读写能力、年龄和种族之间的关系及其对儿童理解和完成 PRO 工具能力的影响。
使用广泛成就测试来评估癌症儿童和青少年的读写能力，他们参与了儿科 PRO-CTCAE 工具的认知访谈。从 8 个地点招募了 140 名参与者（7-20 岁）。逻辑回归和多变量线性回归用于检查关键变量之间的关系。
较高的读写能力得分与较少的 PRO-CTCAE 项目被认为“难以理解”显著相关（p=0.017）。读写能力得分随年龄增长而增加，但与美国标准相比，年龄较大的参与者更有可能落后于预期的阅读水平。年龄增加 1 年与低于预期 WRAT 单词阅读得分的可能性增加 19%（OR 1.19；95%CI 1.06-1.33，p=0.003）相关。种族与读写能力之间没有关联。
在不同的年龄组中注意到读写能力存在很大差异。所有参与者都能够完成儿科 PRO-CTCAE，尽管大多数 7 岁儿童（63%）需要阅读帮助。那些读写能力较低的人能够理解表明理解可能涉及多种因素（发育阶段、注意力、词汇量或先前的健康经验）的项目。随着年龄的增长，读写能力低于预期的风险增加，这意味着癌症患者需要考虑读写能力。
