Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA, USA.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
J Gen Intern Med. 2021 Apr;36(4):938-945. doi: 10.1007/s11606-020-06213-2. Epub 2020 Sep 15.
Limited health literacy is a driver of cancer disparities and associated with less participation in medical decisions. Mammography screening decisions are an exemplar of where health literacy may impact decision-making and outcomes.
To describe informational needs and shared decision-making (SDM) experiences among women ages 40-54 who have limited health literacy and primary care providers (PCPs).
Qualitative, in-depth interviews explored experiences with mammography counseling and SDM.
Women ages 40-54 with limited health literacy and no history of breast cancer or mammogram in the prior 9 months were approached before a primary care visit at a Boston academic, safety-net hospital. PCPs practicing at this site were eligible for PCP interviews.
Interviews were audio-recorded and transcribed verbatim. A set of deductive codes for each stakeholder group was developed based on literature and the interview guide. Inductive codes were generated during codebook development. Codes were compared within and across patient and PCP interviews to create themes relevant to mammography decision-making.
The average age of 25 interviewed patients was 46.5; 18 identified as black, 3 as Hispanic, 2 as non-Hispanic white, and 2 had no recorded race or ethnicity. Of 20 PCPs, 15 were female; 12 had practiced for >5 years. Patients described a lack of technical (appropriate tests and what they do) and process (what happens during a mammogram visit) knowledge, viewing these as necessary for decision-making. PCPs were reluctant to engage patients with limited health literacy in SDM due to time constraints and feared that increased information might confuse patients or deter them from having mammograms. Both groups felt pre-visit education would facilitate mammography-related SDM during clinical visits.
Both patients and PCPs perceived a need for tools to relay technical and process knowledge about mammography prior to clinical encounters to address the scope of information that patients with limited health literacy desired.
健康素养有限是导致癌症差异的因素之一，并且与较少参与医疗决策有关。乳房 X 光筛查决策是健康素养可能影响决策和结果的一个范例。
描述健康素养有限的 40-54 岁女性和初级保健提供者 (PCP) 的信息需求和共享决策 (SDM) 体验。
定性、深入访谈探讨了乳房 X 光检查咨询和 SDM 的经验。
在波士顿一所学术性、保障性医院的初级保健就诊前，接近了年龄在 40-54 岁且健康素养有限、过去 9 个月内没有乳腺癌或乳房 X 光检查史的女性。在该地点执业的 PCP 有资格接受 PCP 访谈。
访谈进行了录音，并逐字转录。根据文献和访谈指南，为每个利益相关者群体制定了一套演绎代码。在代码手册开发过程中生成了归纳代码。在患者和 PCP 访谈中比较了代码，以创建与乳房 X 光决策相关的主题。
接受访谈的 25 名患者的平均年龄为 46.5 岁；18 人被认定为黑人，3 人为西班牙裔，2 人为非西班牙裔白人，2 人没有记录种族或族裔。在 20 名 PCP 中，有 15 名是女性；12 人从业超过 5 年。患者描述了缺乏技术（适当的检查和检查的内容）和流程（乳房 X 光检查就诊期间发生的事情）知识，他们认为这些是决策所必需的。PCP 由于时间限制而不愿意让健康素养有限的患者参与 SDM，并担心增加信息可能会使患者感到困惑或阻止他们进行乳房 X 光检查。两组都认为，在临床就诊前进行教育将有助于在临床就诊期间进行与乳房 X 光相关的 SDM。
患者和 PCP 都认为需要在临床就诊前提供有关乳房 X 光的技术和流程知识的工具，以解决健康素养有限的患者所需的信息范围。
