YOUR OLDER PATIENT
Health Literacy, Communication, and Treatment Decision-Making in Older Cancer Patients
By Sunil Amalraj, MD1, Chelsea Starkweather, MPH2, Christopher Nguyen, BS3, Arash Naeim, MD, PhD4 |
April 13, 2009
1Fellow, UCLA Geriatric Oncology Training Program
4Assistant Professor of Medicine, University of California, Los Angeles
David Geffen School of Medicine, Division of Hematology-Oncology, Los Angeles, California
In the RIAS, the variables describing medical encounter communication are grouped into discrete categories of patient and physician behaviors: instrumental behaviors (information giving/seeking), affective behaviors (positive/negative talk), partnership building, and social conversation.[71,72] Not only is verbal literacy burden taken into account, but the tonal qualities of the conversation are assessed. These tonal qualities give the interaction an emotional context and an affective impression for both the patient and the physician, coding for anger, anxiety, dominance, friendliness, and interest. The RIAS is able to give as complete of an assessment as possible of provider-patient communication.
Older cancer patients are especially vulnerable to poor health literacy and suboptimal communication. There is a need for additional research looking at how health literacy, patient-physician communication, and the presence of companions interact to affect outcomes such as patient self-efficacy, risk communication, and shared decision-making. The conceptual model outlined in Figure 1 provides a broad framework with which to organize future research and locates promising areas for intervention. The issues are relevant not only to cancer patients making routine treatment decisions, but to those who are undergoing procedures or participating in clinical trials where informed consent of the older cancer patient is required.
Although cancer represents one of the most complicated areas in medical decision-making, the issues and framework discussed in this review are applicable to a wide variety of other medical situations. As the baby boomers grow into the next generation of older individuals, the need for effective and efficient means of communicating complex information will be critical.
Financial Disclosure: The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
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