5 Ways to Help Your Cancer Patients Be More Compliant

Neil Chesanow


June 19, 2014

In This Article

Avoid Talking Over Patients' Heads

It can be difficult for physicians who pride themselves on their ability to explain medical concepts to accept that some patients may have little or no idea of what they're talking about, because some doctors may talk over their heads. The patients, ashamed of their inability to understand, are often masters at hiding their ignorance.

However, according to the Institute of Medicine, nearly one half of all adults in the United States -- some 90 million people -- have trouble understanding what the doctor tells them about why they are sick and how to comply with their medication regimens.[8]

Patients who may have problems with health literacy include seniors; young adults; immigrants with a limited grasp of English; people with different cultural belief systems; those with limited education; and persons with visual, aural, or cognitive impairment.[8] The American Medical Association found that poor health literacy is "a stronger predictor of a person's health than age, income, employment status, educational level, and race."[9]

But "you can't tell by looking," cautions Helen Osborne, President of Health Literacy Consulting in Natick, Massachusetts. Even affluent, articulate, educated professionals may also fail to grasp common clinical terms, concepts, and instructions that doctors take for granted are understood, she says.

In cancer screening, for example, studies show that individuals with low health literacy obtain less information from cancer control messages, materials, and conversations.[10] In studies of breast, cervical, prostate, or colon cancer, low-income participants said that they were aware of these cancers, but the investigators found that their knowledge of cancer and cancer screening was limited, often inaccurate, or confused.[11]

In mammography focus groups, many women confused mammograms with Pap smears and associated both with initiating sexual activity or pregnancy.[12] In other focus groups, older women mistakenly believed that advanced age protected them from getting cancer and that cervical cancer was unlikely without sexual activity or after menopause.[13] In colon cancer focus groups, most patients couldn't say or understand the terms "fecal occult blood" or "flexible sigmoidoscopy," and neither physicians nor patients had a workable lay term for either procedure.[14]

Red flags that many indicate a literacy problem include patient registration forms that are incomplete and inaccurate, frequently missed appointments, noncompliance with medication regimens, and lack of follow-through with laboratory or imaging tests or consultant referrals, Osborne says.

"We make a lot of assumptions about health literacy and how much patients really understand about why they need their treatment," says Duke's Zafar. "Every once in a while, after I've explained a complicated treatment plan to a patient, I'll stop and say, 'Just to make sure we're on the same page, why don't you explain back to me what I've just said?' In many instances, I'll get a story that's very different from what I said. That's most likely because I'm not saying it right, but it might also be that because of the patient's goals, aspirations, and motivations, he or she is hearing differently as well."

"Unfortunately, we don't have much formal training in communication, even though, as an oncologist, the majority of what I do is communicate," Zafar laments. "The single most important factor to promote adherence in our patients is communication. If we can communicate to our patients the value in what we're prescribing for them, and the importance of adherence with regard to those prescriptions, the vast majority of patients are able to be adherent to those treatments."


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