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Using Effective Provider-Patient Communication to Improve Cancer Screening Among Low Literacy Patients

This study has been completed.
Robert Wood Johnson Foundation
Information provided by (Responsible Party):
Eboni Price-Haywood, Tulane University School of Medicine Identifier:
First received: May 24, 2011
Last updated: March 9, 2017
Last verified: March 2017

What's the purpose of this study? This 4-year study is designed: (1) to teach primary care physicians how to recognize low health literacy patients and effectively counsel them on cancer screening using risk communication and shared decision making and (2) to assess the impact of training on changes in physician communication behavior and changes in low health literacy patients' cancer screening behaviors. This study proposal is based on the hypothesis that physician training in cancer screening guidelines, health literacy, and communication skills will improve provider-patient interactions during encounters dealing with preventive health maintenance especially cancer screening.

How will the proposed study be implemented? Thirty-two physicians in the New Orleans metropolitan area will be recruited and randomly assigned to one of two groups. The unit of randomization will be the health care organization or clinic. The intervention group will receive training in health literacy, cancer screening, risk communication and shared decision-making. The control group will not receive communication training until the end of the study. Physicians in both groups will undergo three clinic visits with standardized patients (actors trained to portray real patients; mystery shoppers) but they will not be aware that they are conducting visits with actors. The visits will occur at study enrollment and at 6 and 12 months. At the end of each clinic visit, the standardized patients will rate the physicians' communication skills. Each physician assigned to the intervention group will receive verbal feedback on communication skills from the standardized patients and complete a web-based tutorial. Physicians in the control group will not have access to the web-based tutorial until the end of the study.

For each physician, 10-15 patients with limited health literacy will be recruited to the study. Each patient will rate his/her perceived involvement with care and global satisfaction with care at study enrollment and annually for three years. Age and gender-appropriate referral rates for breast, cervical and colorectal cancer screening and patients' receipt of such screening will be assessed annually for three years. All study physicians, regardless of group assignment, will receive performance feedback (report cards) on their cancer screening rates among low health literacy patients in their clinic.

Condition Intervention
Cervical Cancer
Breast Cancer
Colorectal Cancer
Other: Cancer risk communication skills training

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Outcomes Assessor
Primary Purpose: Health Services Research
Official Title: Using Effective Provider-Patient Communication to Improve Cancer Screening Among Low Literacy Patients

Resource links provided by NLM:

Further study details as provided by Tulane University:

Primary Outcome Measures:
  • Change in cervical, breast and colorectal cancer screening rates [ Time Frame: 0, 12, 24 months ]
    Cervical/Breast/Colorectal cancer screening rates will be measured at baseline and annually for 2 years to assess whether screening rates improve over time

Secondary Outcome Measures:
  • Change in standardized patient ratings of physician communication behaviors [ Time Frame: 0, 6, 12 months ]
    The mystery shoppers (standardized patients) will rate the physicians' shared decision making and counseling about cancer screening prior to the intervention at baseline and then again at 6-month and 12-month follow up evaluations to assess whether communication behaviors improve over time

Enrollment: 168
Study Start Date: June 2008
Study Completion Date: June 2012
Primary Completion Date: June 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: No communication training
Physicians enrolled in the control arm do not undergo training in health literacy, cancer screening and shared decision making
Cancer risk ommunication skills training
Physicians enrolled in the intervention arm undergo training in health literacy, cancer screening and shared decision making
Other: Cancer risk communication skills training
Intervention physicians receive training in cancer risk communication and shared decision making (SDM). At the end of each visit with intervention physicians, standardized patients (SPs) reveal themselves as actors and give structured verbal feedback. After baseline SP visits, each intervention physician undergoes academic detailing with a communication expert. Intervention physicians are directed to a web-based communication skills tutorial where SP ratings are hyperlinked to key references for supplemental reading. Both study groups will receive annual reports detailing their patients' cancer screening status and aggregate ratings of their communication style.


Ages Eligible for Study:   40 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:


  • Physicians who practice at these clinic sites at least one half day per week are eligible to participate in this study.


  • Eligible patients include men and women age 40 to 75, individuals enrolled in the clinic practice for at least one year, and individuals identified as having low or inadequate health literacy via the Rapid Estimate of Adult Literacy in Medicine.

Exclusion Criteria:


  • Any provider planning to leave before the end of 12 months will be excluded.


  • Patients will be excluded if they plan to change primary care provider or site of health plan, have resided in the United States for less than five years, or do not speak English
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01361035

United States, Louisiana
Tulane Communty Health Center at Covenant House
New Orleans, Louisiana, United States, 70112
Tulane Faculty Practice
New Orleans, Louisiana, United States, 70112
EXCELth - Ida Hymel Community Health Center
New Orleans, Louisiana, United States, 70114
DCSNO St Cecelia Medical Center
New Orleans, Louisiana, United States, 70117
DCSNO Carrollton Medical Center
New Orleans, Louisiana, United States, 70118
Sponsors and Collaborators
Tulane University School of Medicine
Robert Wood Johnson Foundation
Principal Investigator: Eboni Price-Haywood, MD, MPH Tulane University School of Medicine
  More Information

Responsible Party: Eboni Price-Haywood, Adjunct Associate Professor of Clinical Medicine, Tulane University School of Medicine Identifier: NCT01361035     History of Changes
Other Study ID Numbers: RWJF-63523
Study First Received: May 24, 2011
Last Updated: March 9, 2017

Keywords provided by Tulane University:
health literacy
cancer screening
doctor-patient communication
standardized patient
continuing medical education

Additional relevant MeSH terms:
Colorectal Neoplasms
Uterine Cervical Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Uterine Neoplasms
Genital Neoplasms, Female
Urogenital Neoplasms
Uterine Cervical Diseases
Uterine Diseases
Genital Diseases, Female processed this record on May 23, 2017