Comparative Effectiveness of Audit-Feedback Versus Additional Physician Communication Training to Improve Cancer Screening for Patients with Limited Health Literacy
- 640 Downloads
We designed a continuing medical education (CME) program to teach primary care physicians (PCP) how to engage in cancer risk communication and shared decision making with patients who have limited health literacy (HL).
We evaluated whether training PCPs, in addition to audit-feedback, improves their communication behaviors and increases cancer screening among patients with limited HL to a greater extent than only providing clinical performance feedback.
Four-year cluster randomized controlled trial.
Eighteen PCPs and 168 patients with limited HL who were overdue for colorectal/breast/cervical cancer screening.
Communication intervention PCPs received skills training that included standardized patient (SP) feedback on counseling behaviors. All PCPs underwent chart audits of patients’ screening status semiannually up to 24 months and received two annual performance feedback reports.
PCPs experienced three unannounced SP encounters during which SPs rated PCP communication behaviors. We examined between-group differences in changes in SP ratings and patient knowledge of cancer screening guidelines over 12 months; and changes in patient cancer screening rates over 24 months.
There were no group differences in SP ratings of physician communication at baseline. At follow-up, communication intervention PCPs were rated higher in general communication about cancer risks and shared decision making related to colorectal cancer screening compared to PCPs who only received performance feedback. Screening rates increased among patients of PCPs in both groups; however, there were no between-group differences in screening rates except for mammography. The communication intervention did not improve patient cancer screening knowledge.
Compared to audit and feedback alone, including PCP communication training increases PCP patient-centered counseling behaviors, but not cancer screening among patients with limited HL. Larger studies must be conducted to determine whether lack of changes in cancer screening were due to clinic/patient sample size versus ineffectiveness of communication training to change outcomes.
KEY WORDScommunication shared decision making health literacy cancer screening standardized patients
The authors would like to thank Dr. Roy Weiner for his critical review of this manuscript and Dr. John LeFante for his assistance with examining intraclass correlations for cancer screening outcomes.
This study was funded by the Robert Wood Johnson Foundation Harold Amos Faculty Development Program (Grant # 63523). Dr. Cooper is supported by grants from the National Heart, Lung, and Blood Institute (K24 HL83113 and P50 HL0105187).
This work was presented at the American Association for Cancer Research 3rd and 4th Annual Cancer Health Disparities Conferences in October 2010 and September 2011.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S: Government Printing Office; 2000. November.Google Scholar
- 5.Aboumatar HJ, Carson KA, Beach MC, Roter DL, Cooper LA. The Impact of Health Literacy on Desire for Participation in Healthcare, Medical Visit Communication, and Patient Reported Outcomes among Patients with Hypertension. J Gen Intern Med. 2013 May 21. [Epub ahead of print].Google Scholar
- 18.Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken). 2011;63:S383–412.PubMedCrossRefGoogle Scholar
- 19.Stretcher VJ, Rosenstock JM. The Health Belief Model. Health Behavior and Health Education. San Francisco: Jossey-Bass; 1997. p. 41–59.Google Scholar
- 32.Sabatino SA, Lawrence B, Elder R, et al. Community Preventive Services Task Force. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med. 2012;43:97–118.PubMedCrossRefGoogle Scholar