Patient Numeracy, Perceptions of Provider Communication, and Colorectal Cancer Screening Utilization

Abstract

Patients with poor numeracy skills may have difficulty participating in shared-decision making, affecting their utilization of colorectal cancer (CRC) screening. We explored the relationship between numeracy, provider communication, and CRC screening. Data were from the 2007 National Cancer Institute Health Information Trends Survey. Individuals age 50 years or older responded via mail or phone to items measuring numeracy, perceptions of provider communication quality, and CRC screening. After accounting for national sampling weights, multivariate logistic regression models examined the association between these factors. A total of 1,436 subjects responded to an objective numeracy item via mail, and 3,286 responded to a subjective numeracy item via mail or phone; 22.6% had low objective numeracy, and 39.4% had low subjective numeracy. Low subjective numeracy was associated with a lower likelihood of perceiving high quality provider communication (OR 0.63–0.73), but for low objective numeracy, the opposite was observed (OR 1.51–1.64). Low objective or subjective numeracy was associated with less CRC screening. There was significant interaction between subjective numeracy, perceptions of provider communication, and CRC screening. Patient numeracy is associated with perceptions of provider communication quality. For individuals with low subjective numeracy, perceiving high quality communication offset the association between low numeracy and underutilization of CRC screening.

Acknowledgments

Philip Ciampa is currently supported by the Veteran's Affairs Quality Scholars Fellowship Program. Chandra Osborn is currently supported by a Diversity Supplement Award (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] P60 DK020593). Neeraja Peterson is currently supported by a National Cancer Institute (NCI) Career Development Award (NCI 5K07 CA122827). Russell Rothman is currently supported by an NIDDK Career Development Award (NIDDK 5K23 DK065294).

Notes

†Other includes Asian American, Native American, Pacific Islander, Native Hawaiian, and multiple races.

†Adjusted for age, gender, race, income education, and health insurance.

*p < .001.

**p < .05.

^a Item 1: How often did doctors, nurses or other health professionals give you the chance to ask all the health-related questions you had?

^b Item 2: How often did doctors, nurses or other health professionals give the attention you needed to your feelings and emotions?

^c Item 3: How often did they involve you in decisions as much as you wanted?

^d Item 4: How often did they make sure you understood the things you needed to do to take care of your health?

†Adjusted for Age, Gender, Race, Income, Education and Health Insurance.

*p < .05.