The Impact of Numeracy on Verbatim Knowledge of the Longitudinal Risk for Prostate Cancer Recurrence following Radiation Therapy

Hamstra, Daniel A.; Johnson, Skyler B.; Daignault, Stephanie; Zikmund‐Fisher, Brian J.; Taylor, Jeremy M. G.; Larkin, Knoll; Wood, Alexander; Fagerlin, Angela

doi:10.1177/0272989x14551639

Cited by 32 publications

(43 citation statements)

References 27 publications

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“…In a Cochrane review (2013) on the value of personalized risk communication, the authors concluded that incorporating personalized risk estimates increases knowledge, may increase accuracy of risk and enhance informed choices, but may not significantly affect an individual’s anxiety [14,50]. However, identifying women who are anxious or worry about recurrence and simultaneously managing their worry with supportive care while correcting misconceptions about recurrence risk seems like a reasonable approach [21,24,51]. Our findings do suggest that physicians are more likely to inquire about worry among women who themselves report the most worry.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings do suggest that physicians are more likely to inquire about worry among women who themselves report the most worry. Notably, many oncologists and surgeons report lack of confidence in managing worry about recurrence with their patients [12,24]. …”

Section: Discussionmentioning

confidence: 99%

“…For some women, these discussions may be particularly challenging and require additional time and/or personalized approaches based on individual factors [21–23]. For example, less numerate women may require presentation of risk using formats that do not depend solely on numbers [19,24,25]. Women with low health literacy find discussions about risk challenging but are less likely to ask questions [23,26,27].…”

Section: Introductionmentioning

confidence: 99%

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The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

Janz

Zikmund‐Fisher

et al. 2016

Breast Cancer Res Treat

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Purpose Doctor-patient communication is the primary way women diagnosed with breast cancer learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions. Methods A weighted random sample of newly diagnosed early stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013–2015) were sent surveys ~about 2 months after surgery (Phase 2, N=3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically-determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women’s perceived risk of distant recurrence (0–100%) was categorized into subgroups: overestimation, reasonably accurate, zero risk. Understanding of risk and patient factors (e.g., health literacy, numeracy and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295). Results About 33% of women reported doctors discussed risk of recurrence “quite a bit” or “a lot” while 14% said “not at all.” Over half of women reported doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR =.50, CI 0.31, 0.81) or those who perceived zero risk (OR =.46, CI 0.29,0.72) more often said their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported their doctor almost never inquired about worry. Conclusions Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians’ ability to engage in individualized communication around risk are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

Janz

Zikmund‐Fisher

et al. 2016

Breast Cancer Res Treat

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“…Furthermore, interference with DNA repair via PARP inhibition using Olaparib (AZD 2281) or Niraparib (MK 4827) may initially sensitize cells via increased autophagy and senescence, but not apoptosis. However, this strategy does not appear to interfere with proliferative recovery, which could, in theory, contribute to disease recurrence [34–37]. …”

Section: Introductionmentioning

confidence: 99%

Radiosensitization by PARP Inhibition in DNA Repair Proficient and Deficient Tumor Cells: Proliferative Recovery in Senescent Cells

Alotaibi¹,

Sharma²,

Saleh³

et al. 2016

Radiation Research

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Radiotherapy continues to be a primary modality in the treatment of cancer. DNA damage induced by radiation can promote apoptosis as well as both autophagy and senescence, where autophagy and senescence can theoretically function to prolong tumor survival. A primary aim of this work was to investigate the hypothesis that autophagy and/or senescence could be permissive for DNA repair, thereby facilitating tumor cell recovery from radiation-induced growth arrest and/or cell death. In addition, studies were designed to elucidate the involvement of autophagy and senescence in radiation sensitization by PARP inhibitors and the re-emergence of a proliferating tumor cell population. In the context of this work, the relationship between radiation-induced autophagy and senescence was also determined. Studies were performed using DNA repair proficient HCT116 colon carcinoma cells and a repair deficient Ligase IV (−/−) isogenic cell line. Irradiation promoted a parallel induction of autophagy and senescence that was strongly correlated with the extent of persistent H2AX phosphorylation in both cell lines; however inhibition of autophagy failed to suppress senescence, indicating that the two responses were dissociable. Irradiation resulted in a transient arrest in the HCT116 cells while arrest was prolonged in the Ligase IV (−/−) cells; however, both cell lines ultimately recovered proliferative function, which may reflect maintenance of DNA repair capacity. The PARP inhibitors (Olaparib) and (Niraparib) increased the extent of persistent DNA damage induced by radiation as well as the extent of both autophagy and senescence; neither cell line underwent significant apoptosis by radiation alone or in the presence of the PARP inhibitors. Inhibition of autophagy failed to attenuate radiation sensitization, indicating that autophagy was not involved in the action of the PARP inhibitors. As with radiation alone, despite sensitization by PARP inhibition, proliferative recovery was evident within a period of 10–20 days. While inhibition of DNA repair via PARP inhibition may initially sensitize tumor cells to radiation via the promotion of senescence, this strategy does not appear to interfere with proliferative recovery, which could ultimately contribute to disease recurrence.

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“…Despite previous research testing pictographs against other graphic formats, only little attention has been paid to the question of how exactly these pictographs should look, and thus which icon type to use in a pictograph. Thus, pictographs include a variety of icon types for displaying risks, without a scientific basis for whether the concreteness of the iconicity in pictographs facilitates or impedes the comprehension of medical risk information.…”

Section: Introductionmentioning

confidence: 99%

Does Iconicity in Pictographs Matter? The Influence of Iconicity and Numeracy on Information Processing, Decision Making, and Liking in an Eye‐Tracking Study

2016

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Researchers recommend the use of pictographs in medical risk communication to improve people's risk comprehension and decision making. However, it is not yet clear whether the iconicity used in pictographs to convey risk information influences individuals' information processing and comprehension. In an eye-tracking experiment with participants from the general population (N = 188), we examined whether specific types of pictograph icons influence the processing strategy viewers use to extract numerical information. In addition, we examined the effect of iconicity and numeracy on probability estimation, recall, and icon liking. This experiment used a 2 (iconicity: blocks vs. restroom icons) × 2 (scenario: medical vs. nonmedical) between-subject design. Numeracy had a significant effect on information processing strategy, but we found no effect of iconicity or scenario. Results indicated that both icon types enabled high and low numerates to use their default way of processing and extracting the gist of the message from the pictorial risk communication format: high numerates counted icons, whereas low numerates used large-area processing. There was no effect of iconicity in the probability estimation. However, people who saw restroom icons had a higher probability of correctly recalling the exact risk level. Iconicity had no effect on icon liking. Although the effects are small, our findings suggest that person-like restroom icons in pictographs seem to have some advantages for risk communication. Specifically, in nonpersonalized prevention brochures, person-like restroom icons may maintain reader motivation for processing the risk information.

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The Impact of Numeracy on Verbatim Knowledge of the Longitudinal Risk for Prostate Cancer Recurrence following Radiation Therapy

Cited by 32 publications

References 27 publications

The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

Radiosensitization by PARP Inhibition in DNA Repair Proficient and Deficient Tumor Cells: Proliferative Recovery in Senescent Cells

Does Iconicity in Pictographs Matter? The Influence of Iconicity and Numeracy on Information Processing, Decision Making, and Liking in an Eye‐Tracking Study

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