Engaging Women with Limited Health Literacy in Mammography Decision-Making: Perspectives of Patients and Primary Care Providers
Limited health literacy is a driver of cancer disparities and is associated with less participation in medical decisions. Mammography screening decisions are a common example of this. Women with limited health literacy and their primary care providers were interviewed about their informational needs and shared decision-making experiences. Patients described a lack of technical (appropriate tests and their function) and process (what happens during a mammogram visit) knowledge, and considered these to be necessary for decision-making. Primary care providers were reluctant to engage patients with limited health literacy in shared decision making due to time constraints and feared that more information might confuse patients or deter them from having mammograms. Both groups felt pre-visit education would facilitate mammography-related shared decision making during clinical visits. Both patients and primary care providers perceived a need for tools to relay technical and process knowledge about mammography prior to clinical encounters to address the scope of information that patients with limited health literacy desired. This study highlights strategies that might support patients with limited health literacy, including avoiding the assumption that mammography is common knowledge and sharing the process-focused information about breast cancer screening that patients desire.