Health literacy, communication, and treatment decision-making in older cancer patients

Inadequate health literacy and physician-patient communication are associated with poor health outcomes and appear to limit quality of medical decision-making. This review presents and consolidates data concerning health literacy, physician-patient communication, and their impact on medical treatment decisions in elderly cancer patients. This population faces increasingly complex management options, cognitive and sensory deficits, and intergenerational barriers. As a result of these and other factors, older cancer patients have among the lowest health literacy and numeracy rates and often suffer from suboptimal physician-patient communication. These deficiencies impair elderly cancer patients' ability to understand, recall, and act upon information concerning treatment risk and benefit. This situation also makes it difficult for patients to have self-confidence in communicating with their provider and sharing in the decision-making. Moreover, since older cancer patients usually bring a companion to medical appointments, the positive and negative role of a companion in the context of communication and decision-making needs to be considered. Future research should center on developing ways to identify and overcome health communication barriers to improve geriatric cancer care.