title: Misperceptions of medical understanding in low-literacy patients: implications for cancer prevention.
abstract: BACKGROUND
  Patients with limited literacy skills often have difficulty understanding medical information, are less likely to undergo cancer screening, and present with cancer at later stages than patients with better literacy skills. Since primary care physicians are responsible for performing or initiating the majority of cancer screening in the United States, they need to be able to not only identify patients who might not understand medical information but also communicate effectively with them about cancer prevention and screening.
  
  
  METHODS
  To determine whether family medicine residents could identify patients who might have difficulty understanding medical information because of limited literacy, we measured the literacy skills of patients in a university-based family medicine clinic using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). After the patients completed their office visits with a physician, we asked family medicine residents to rate the patients' ability to understand medical information.
  
  
  RESULTS
  Among 140 patients who met with 18 family medicine resident physicians, 24% had limited literacy skills based on testing with the S-TOFHLA. Residents identified only about half of these patients as having poor or below average understanding of medical information.
  
  
  CONCLUSIONS
  IN many cases, family medicine residents are unable to identify patients who, based on assessment of their literacy skills, are likely to have difficulty understanding medical information. When working with residents, medical educators should promote the habit of taking poor literacy into account when communicating with patients.
authors.affiliation: Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville 37920, USA. esrogers@mc.utmck.edu
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Rogers
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
authors.forename: Barry D
authors.initials: BD
authors.lastname: Weiss
mesh_terms: D003142:Communication; D032882:Comprehension; D003695:Delivery of Health Care; D004522:Educational Status; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control* / Q000523:psychology; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations