Bus reading:
Health Literacy not Race Predicts End-of-Life Care Preferences/ Journal of Palliative Medicine V11, N5 2008.
This article is a tough read because it raises so many hot-button issues that it is hard to read it through with an open mind. Issues like race, education and how we make decisions for ourselves and our families about life and death medical situations.
Here is the quick version: people over 40 who were scheduled to see an internist were asked to participate in a study (greater Boston area). They then listened to a simple verbal description of advanced dementia and were asked to choose from three levels of care in the event they developed advanced dementia themselves, namely:
Here is what they found after the verbal description only:
86% of whites preferred comfort care
56% African Americans preferred comfort care
However, (statistical analysis and explanation that I am not able to summarize due to lack of skill goes here) the effect of race is not significant. Neither were age, gender marital status, religion, religious attendance or health status.
It is low health literacy that predicts which level of care a participant chose after listening to a description of advanced dementia in this study.
After the video, the vast majority of subjects across both races and all health literacy rates chose comfort care.
The discussion in this article says it well:
the importance of patient education and communication is corroborated by the finding in our study that a video intervention designed to compensate for low health literacy skills had a large impact on patient preferences. And
Carefully crafted video decision aids designed to overcome barriers posed by health literacy may improve decision making at the end of life for patients with low health literacy.
Still, the article raises questions. I do love questions!
Why did a video change people's minds- is it because they did not understand the implications of living with advanced dementia based only on a verbal description (as the article seems to prove?) Why is that?
Isn't it more a question of imagination in that case, of hearing words and creating a mental video of what they represent? It seems that the video caused words to be translated into images into feelings and then into decisions. Powerful.
If low health literacy means the inability to create compelling mental videos then are our efforts to increase health literacy designed for success?
Is it ok to use a video that may be strongly emotional (manipulative?) to change people's minds? In what situations? To motivate them to lose weight? Use good hand washing technique? Stop smoking?
Here is the quick version: people over 40 who were scheduled to see an internist were asked to participate in a study (greater Boston area). They then listened to a simple verbal description of advanced dementia and were asked to choose from three levels of care in the event they developed advanced dementia themselves, namely:
- life prolonging care
- limited care (to maintain physical functioning)
- comfort care
Here is what they found after the verbal description only:
86% of whites preferred comfort care
56% African Americans preferred comfort care
However, (statistical analysis and explanation that I am not able to summarize due to lack of skill goes here) the effect of race is not significant. Neither were age, gender marital status, religion, religious attendance or health status.
It is low health literacy that predicts which level of care a participant chose after listening to a description of advanced dementia in this study.
After the video, the vast majority of subjects across both races and all health literacy rates chose comfort care.
The discussion in this article says it well:
the importance of patient education and communication is corroborated by the finding in our study that a video intervention designed to compensate for low health literacy skills had a large impact on patient preferences. And
Carefully crafted video decision aids designed to overcome barriers posed by health literacy may improve decision making at the end of life for patients with low health literacy.
Still, the article raises questions. I do love questions!
Why did a video change people's minds- is it because they did not understand the implications of living with advanced dementia based only on a verbal description (as the article seems to prove?) Why is that?
Isn't it more a question of imagination in that case, of hearing words and creating a mental video of what they represent? It seems that the video caused words to be translated into images into feelings and then into decisions. Powerful.
If low health literacy means the inability to create compelling mental videos then are our efforts to increase health literacy designed for success?
Is it ok to use a video that may be strongly emotional (manipulative?) to change people's minds? In what situations? To motivate them to lose weight? Use good hand washing technique? Stop smoking?
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