Purpose: To ascertain the literacy and numeracy skills of Veterans at 4 VAs and determine it’s impact on anxiety, perceptions of active cancer treatment, and shared decision making.
Method: 574 men were recruited for a study testing two decision aids for early stage prostate cancer. Men were recruited at their prostate biopsy appointment at either Ann Arbor, Durham, Pittsburgh, or San Francisco VA. 83% of patients identified themselves as Caucasian and 16% as African American. As a part of a baseline questionnaire, each patient completed literacy (REALM) and numeracy (Subjective Numeracy Scale) measures. Patients also completed questions about their beliefs about cancer treatment (e.g. “How important is it to treat cancer, whether or not it makes a difference in survival?”), their anxiety about prostate cancer, and their preference for shared decision making about prostate cancer.
Result: 26% of men were classified as having inadequate literacy and 74% men demonstrated adequate literacy. The mean numeracy score was 4.57 (SD=1.04, range = 1-6). Literacy and numeracy was moderately correlated, r = 0.24, p<0.001. Literacy and numeracy both differed by race with Whites having higher literacy (Χ2= 18.42, p<0.001) and higher numeracy (4.64 vs. 4.23, F=13.05, p<0.001). More specifically, 44% of people who did not identify as White demonstrated inadequate literacy, whereas 23% of Whites had inadequate literacy. Those with adequate literacy were less anxious about prostate cancer than those with inadequate literacy (M = 0.93 vs. 1.20, Χ2 = 28.83, p<0.001), with similar findings for numeracy. Individuals with inadequate health literacy were more likely to endorse the following statements “important to treat cancer whether or not it makes a difference in survival”, “important to do what doctor thinks is best”, “doing everything to fight cancer is a right choice”, “only responsible thing is to do some sort of active treatment” (all p’s<0.001). There were no literacy or numeracy differences in people’s interest in shared decision making for prostate cancer treatment.
Conclusion: While the majority of Veterans have adequate literacy, a significant minority does not, and almost half of underrepresented minorities have inadequate literacy. Those with inadequate literacy more strongly endorse having active treatment, even if not beneficial, and have increased anxiety about the health condition they were being seen for.