title: Health literacy-listening skill and patient questions following cancer prevention and screening discussions.
abstract: Patient question-asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question-asking as a function of health literacy with respect to spoken information (health literacy-listening).
  
  
  
  Four-hundred and thirty-three (433) adults listened to simulated physician-patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy-listening was assessed using the Cancer Message Literacy Test-Listening (CMLT-Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT-Listening asked a similar variety of questions.
  
  
  
  Questions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT-Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education.
  
  
  
  Patients' health literacy-listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.
authors.affiliation: Meyers Primary Care Institute, Worcester, MA, USA.|Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.affiliation: University of Georgia, Athens, GA, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Rubin
authors.affiliation: Health Management and Policy, Georgia State University, Atlanta, GA, USA.|Kaiser Permanente Georgia, Atlanta, GA, USA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Roblin
authors.affiliation: Maine Medical Center Research Institute, Portland, ME, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Williams
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.
authors.forename: Paul K J
authors.initials: PK
authors.lastname: Han
authors.affiliation: Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: Gaglio
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cutrona
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Costanza
authors.affiliation: Meyers Primary Care Institute, Worcester, MA, USA.
authors.forename: Joann L
authors.initials: JL
authors.lastname: Wagner
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000517:prevention & control* / Q000523:psychology*; D032882:Comprehension; D003657:Decision Making; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000517:prevention & control*; D011594:Psychometrics; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: cancer screening; health literacy; patient engagement; physician-patient communication