Oral cancer educational materials for the general public: 1998

[Oral health competence and its communication in "talking dentistry"]

The concept of health literacy has received much attention in recent years. Essential approaches are the provision of health information, teaching through educational programs, and transfer via communication techniques. From a dental point of view, the individual discussion between patient and dentist is of particular importance ("talking dentistry").The aim of our article is to present the current state of knowledge on the relationship between oral health literacy and talking dentistry, to present existing concepts for teaching communicative competencies, and to identify the further need for action from the point of view of the German Dental Association. Several health psychology models emphasize a positive relationship between oral health literacy, oral health behavior, and oral health. Further determinants seem to be the patient's self-efficacy beliefs and the individual interaction with the dentist. Therefore, it seems purposeful to intervene in an occasion-related manner in the sense of talking dentistry. The personal conversation between dentist and patient can cover counselling, education, motivation, and practical guidance and can lead to participatory decision-making.Offers for learning and deepening communication techniques represent important aids for the practice. Some are presented in this article as examples. However, in order to establish talking dentistry on a broad level, more far-reaching offers and incentives are needed. Through our suggestions, we would like to show ways in which talking dentistry can be further promoted and consolidated as an integral part of dental care.

Screening Projects for Oral Carcinoma in Relation to Health Education and Patients' Compliance: Study on 600 Participants

Aims and Objectives:

The lack of information among the population regarding the existence of oral squamous cell carcinoma (OSCC) and the lack of attention and expertise in examining the oral cavity of dentists and clinicians still remain very worrying and could explain the high incidence of OSCC. The aim of this study is to evaluate the level of awareness of OSCC among 600 participants from Southern Italy.

Materials and Methods:

A 13-question survey was prepared and distributed to 600 participants divided into two subgroups, the first one of 300 patients referring to the Department of Neuroscience, Reproductive, and Odontostomatological Sciences, University Federico II of Naples, for the treatment of dental pathologies, and the second one of 300 patients referring to the Department of Internal Medicine of the Second University of Naples for the diagnosis and treatment of cardiovascular diseases. Statistical analysis consisted in the calculation of percentages related to the answers given by patients. Comparison of percentages was after performed between the two subgroups.

Result:

Only 175 participants (29.1%) knew about the existence of pathologies which can affect the oral mucosa, and only 46 (7.6%) were aware that carcinoma can arise in the oral cavity; 345 (57,5%) stated that they had periodical dental visits, at least once a year but none of them stated they had a visit for the identification of oral carcinomas.

Conclusion:

The data acquired must be taken into consideration to outline essential socio-healthcare educational projects on carcinoma and its risk factors, training programs to increase dentists and clinicians’ competences, and to evaluate the feasibility and effectiveness of oral carcinoma screening programs.

The double-edged sword of ovarian cancer information for women at increased risk who have previously taken part in screening

BACKGROUND

Women at increased risk who decide not to have, or to delay, risk-reducing salpingo-oophorectomy have to rely on early diagnosis through symptom awareness and presenting to primary care as soon as possible in the absence of screening. However, little is known about the acceptability to women of this strategy. We aimed to gain an in-depth understanding of women's perceptions and previous experiences of ovarian cancer symptom management, and the influences on ovarian cancer awareness and anticipated symptom presentation.

METHOD

Qualitative interviews were conducted with eight women at increased risk of ovarian cancer who had previously taken part in ovarian cancer screening and analysed using interpretative phenomenological analysis (IPA).

RESULTS

Familial experience of ovarian cancer and perceived personal risk shaped women's perceptions and behavioural responses to disease threat. Ovarian cancer information was perceived to be a double-edged sword, regarded as either useful for increasing knowledge and confidence in discussing symptom concerns with health professionals or to be avoided due to fears about cancer.

CONCLUSION

Women may be cautious about searching for information independently and in the absence of routine ovarian screening.

PRACTICE IMPLICATIONS

Thought needs to be given to how best to create and disseminate credible ovarian cancer symptom information materials.

Are we able to reduce the mortality and morbidity of oral cancer; some considerations

Oral cancer makes up 1%-2% of all cancers that may arise in the body. The majority of oral cancers consists of squamous cell carcinomas. Oral cancer carries a considerable mortality rate, being mainly dependent on the stage of the disease at admission. Worldwide some 50% of the patients with oral cancer present with advanced disease. There are several ways of trying to diagnose oral cancer in a lower tumor stage, being 1) mass screening or screening in selected patients, 2) reduction of patients’ delay, and 3) reduction of doctors’ delay. Oral cancer population-based screening (“mass screening”) programs do not meet the guidelines for a successful outcome. There may be some benefit when focusing on high-risk groups, such as heavy smokers and heavy drinkers. Reported reasons for patients’ delay range from fear of a diagnosis of cancer, limited accessibility of primary health care, to unawareness of the possibility of malignant oral diseases. Apparently, information campaigns in news programs and TV have little effect on patients’ delay. Mouth self-examination may have some value in reducing patients’ delay. Doctors’ delay includes dentists’ delay and diagnostic delay caused by other medical and dental health care professionals. Doctors’ delay may vary from almost zero days up to more than six months. Usually, morbidity of cancer treatment is measured by quality of life (QoL) questionnaires. In the past decades this topic has drawn a lot of attention worldwide. It is a challenge to decrease the morbidity that is associated with the various treatment modalities that are used in oral cancer without substantially compromising the survival rate. Smoking cessation contributes to reducing the risk of oral cancers, with a 50% reduction in risk within five years. Indeed, risk factor reduction seems to be the most effective tool in an attempt to decrease the morbidity and mortality of oral cancer.

Key words:Oral cancer, early diagnosis, quality of life.

'English leaflets are not meant for me': a qualitative approach to explore oral health literacy in Chinese mothers in Southwestern Sydney, Australia

OBJECTIVES

The aim of this study was to record the views of Chinese mothers living in southwestern Sydney on the value of commonly used dental health education materials that gave behavioural advice on looking after the oral health of young children.

METHODS

This qualitative study was nested within a large cohort study in south-western Sydney. Chinese-speaking mothers (n = 27) with young children were approached for a face-to-face, semi-structured interview at their home. Two dental leaflets in English that gave behavioural advice on monitoring young children's oral health were sent to each mother prior to interview. On the day of the interview, mothers were also given translated versions of the leaflets for comparison. Interviews were recorded and subsequently transcribed verbatim. Transcripts were analysed by thematic coding.

RESULTS

Mothers reported that the leaflets were not tailored to match the different levels of English literacy within the Chinese community, and participants favoured health information material written in their first language with the use of illustrations. However, translations had to take account of the Chinese culture, as some of the advice in the leaflets presented did not reflect Chinese family values. Mothers also felt that the information should be more specific to provide a better understanding of the rationale for changing or implementing a different behaviour.

CONCLUSIONS

Dental health information literature for Chinese people should not be translated directly from those intended for an English-speaking audience, but should reflect Chinese culture-specific advice such as examples of the type and amount of foods to be given during early years of life. Supportive illustrations were also preferred.

Oral health literacy levels among a low-income WIC population

OBJECTIVES

To determine oral health literacy (OHL) levels and explore potential racial differences in a low-income population.

METHODS

This was a cross-sectional study of caregiver/child dyads that completed a structured 30-minute in-person interview conducted by two trained interviewers in seven counties in North Carolina. Sociodemographic, OHL, and dental health-related data were collected. OHL was measured with a dental word recognition test [Rapid Estimate of Adult Literacy in Dentistry (REALD-30)]. Descriptive, bivariate, and multivariate methods were used to examine the distribution of OHL and explore racial differences.

RESULTS

Of 1658 eligible subjects, 1405 (85 percent) participated and completed the interviews. The analytic sample (N=1280) had mean age 26.5 (standard deviation = 6.9) years with 60 percent having a high school degree or less. OHL varied between racial groups as follows: Whites--mean score = 17.4 (SE = 0.2); African-American (AA)--mean score = 15.3 [standard error (SE) = 0.2]; American Indian (AI)--mean score = 13.7 (SE = 0.3). Multiple linear regression revealed that after controlling for education, county of residence, age, and Hispanic ethnicity, Whites had 2.0 points (95 percent CI = 1.4, 2.6) higher adjusted REALD-30 score versus AA and AI.

CONCLUSIONS

Differences in OHL levels between racial groups persisted after adjusting for education and sociodemographic characteristics.

Healthcare organizations, linguistic communities, and the emblematic model of palliative care

The linguistic-communicative paradigm offers some interesting perspectives in a context where the perception of patient needs is considered a critical step in high-quality care. This study describes healthcare organizations as linguistic communities based on the conceptual framework of Habermas' communicative action theory. Four communicative models are present in healthcare settings: objectifying-instrumental (hegemonic model), where elements of interaction are objectified for clinical purposes; dialogic model with strategic perspectives, in which conversations are used unilaterally as tools to access subjective states; non-dialogic-transmissional model, in which linguistic exchanges are replaced with artifacts to transmit information; and full communicative model (present in palliative care based in homecare and informal caregivers, emphasizing health team/family interactions). Based on these premises, we considered palliative care an emblematic communicative model based on multidisciplinary teams devoted to transdisciplinary collaboration. In these settings, linguistic interaction with patients and their families could provide a solid basis for organization of healthcare networks.

The cultural and social context of oral and pharyngeal cancer risk and control among Hispanics in New York

New York City (NYC) has one of the highest incidence and mortality rates of oral and pharyngeal cancer (OPC) for Hispanics of any major U.S. city. This qualitative assessment explores OPC awareness, attitudes, and screening practices among at-risk Hispanics, health care providers, and community leaders in a Hispanic neighborhood of NYC. Four focus groups (N=39) were conducted with at-risk Hispanics. Structured interviews were conducted with ten health care providers (four physicians, four dentists, two dental hygienists) and three key community leaders. Results showed major gaps in OPC awareness across all key stakeholders. Focus group participants expressed difficulty in accessing appropriate health care. Health care providers were not familiar with OPC prevention and early detection practices. Community leaders lacked the knowledge and resources necessary for advocating prevention and early detection for their constituencies. All participants reported cultural, social, and structural barriers to prevention. There is a need for developing a comprehensive, culturally competent health communication program that targets all key stakeholders in the at-risk Hispanic community of NYC.

Evaluation of a Word Recognition Instrument to Test Health Literacy in Dentistry: The REALD-99

OBJECTIVE

This study aims to evaluate a dental health literacy word recognition instrument.

METHODS

Based on a reading recognition test used in medicine, the Rapid Estimate of Adult Literacy in Medicine (REALM), we developed the Rapid Estimate of Adult Literacy in Dentistry (REALD-99). Parents of pediatric dental patients were recruited from local dental clinics and asked to read aloud words in both REALM and REALD-99. REALD-99 scores had a possible range of 0 (low literacy) to 99 (high literacy); REALM scores ranged from 0 to 66. Outcome measures included parents' perceived oral health for themselves and of their children, and oral health-related quality of life of the parent as measured by the short-form Oral Health Impact Profile (OHIP-14). To determine the validity, we tested bivariate correlations between REALM and REALD-99, REALM and perceived dental outcomes, and REALD-99 and perceived dental outcomes. We used ordinary least squares regression and logit models to further examine the relationship between REALD-99 and dental outcomes. We determined internal reliability using Cronbach's alpha.

RESULTS

One hundred two parents of children were interviewed. The average REALD-99 and REALM-66 scores were high (84 and 62, respectively). REALD-99 was positively correlated with REALM (PCC = 0.80). REALM was not related to dental outcomes. REALD-99 was associated with parents' OHIP-14 score in multivariate analysis. REALD-99 had good reliability (Cronbach's alpha = 0.86).

CONCLUSIONS

REALD-99 has promise for measuring dental health literacy because it demonstrated good reliability and is quick and easy to administer. Additional studies are needed to examine the validity of REALD-99 using objective clinical oral health measures and more proximal outcomes such as behavior and compliance to specific health instructions.

A systematic review of readability and comprehension instruments used for print and web-based cancer information

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.

An evaluation of the quality of commercially produced patient information leaflets

AIM

A descriptive study was undertaken to assess the quality of a range of patient information leaflets produced by the British Dental Association.

METHOD

Twenty-nine leaflets were assessed with regard to presentation, readability and quality. The topic areas covered included: treatment, self-care and disease related information. Presentation was evaluated with regard to layout, font size, typeface, use of illustrations, paper type and print colour. Readability was assessed using the Flesch reading grade and the SMOG reading grade. Quality was assessed using the DISCERN tool.

FINDINGS

All leaflets scored quite well for readability, with the average SMOG Reading Grade Level being 9.10 (SD 0.80) and the average Flesch reading Grade Level being 6.18 (SD 0.83). There were, however, some areas of presentation that could be improved, specifically font size, illustration use and paper finish, which did not comply with the RNIB guidelines. Quality ratings using the DISCERN tool were low. In particular most leaflets scored poorly in setting out clear aims in the opening paragraph, in identifying sources and dates of information provided, and other sources of advice and support available. Few leaflets discussed the option of no treatment or how the treatment would affect overall quality of life. The role of shared decision making was rarely mentioned.

CONCLUSION

Patient information leaflets produced commercially are of high production quality and good readability but tend not to be patient centred.

The American Dental Association's oral cancer campaign: the impact on consumers and dentists

BACKGROUND

The ADA conducted a public service campaign in late 2001 to raise awareness of oral cancer and of the dentist's role in early detection.

METHODS

To gather information about the impact of this campaign, the ADA undertook two surveys. A telephone survey was conducted among 1,270 adult consumers, and a second survey was mailed to a national sample of 2,500 dentists.

RESULTS

The majority of the consumers did not recognize the fact that dentists are responsible for examining their patients for oral cancer and that oral cancer claims more lives than melanoma or cervical cancer. The majority of dentists was aware of the ADA campaign and agreed that it helped raise the public's awareness of oral cancer and the importance of early detection. As a result, more dentists said that they are likely to educate their patients about early detection, adjust their own practice routines to include discussion about the disease, and look more closely for small oral lesions and test them with the brush biopsy test.

CONCLUSIONS

The results of the survey of dentists demonstrated that the oral cancer awareness initiative sponsored by the ADA resulted in positive behavioral changes targeted toward the early detection of oral cancer.

CLINICAL IMPLICATIONS

Continued efforts to provide health education and health promotion interventions aimed at consumers and dentists invariably will result in the detection of oral cancers at early and curable stages.

Oral cancer knowledge and examination experiences among North Carolina adults

OBJECTIVE

This study assesses knowledge of oral cancer risk factors, clinical signs, and oral cancer examination experience among North Carolina adults.

METHODS

A statewide random digit dial, computer-assisted telephone interview was conducted in 2002. Data from 1,096 respondents, with a response rate of 62 percent, were poststratified to 2000 census data by sex, race, and age group to produce population-based estimates. Knowledge of one sign of oral cancer, four or more risk factors for oral cancer, and having ever had an oral cancer examination were compared in logistic regression models using normalized weights.

RESULTS

Fourteen (95% confidence interval [CI] +/-2) percent of adults had never heard of oral or mouth cancer. Risk factor knowledge was high for 56 percent (95% CI+/-3) and associated in a logistic regression model with younger age, feeling personal factors cause cancer, and nonuse of snuff. One sign of oral cancer (sore/lesion, red or white patch in mouth, and bleeding in the mouth) was correctly identified by 53 percent (95% CI+/-3) with significantly more correct responses from younger people, nonsmokers, and some college education. Only 29 percent (95% CI+/-3) reported ever having had an oral cancer examination when this procedure was described. Most respondents reported exams performed by dentists. In a weighted logistic regression model, older age, being dentate, nonsmokers, alcohol users, and those with some college education were significantly more likely to report having ever had an oral cancer examination.

CONCLUSIONS

Although there is moderate knowledge of signs and risk factors for oral cancer among North Carolina adults, knowledge deficits remain. Oral cancer examinations need to be increased, particularly among tobacco smokers.

Risk perception of oral cancer in smokers attending primary care: a randomised controlled trial

To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written information for those at high risk of oral cancer, especially for tobacco smokers. This study investigated three hypotheses: first that a patient information leaflet (PIL) would enhance risk perceptions, and second that the effect of the leaflet on knowledge would be confirmed as in previous studies and third that these improvements would be associated with smoking behaviour. Patients (N = 995) attending 20 general dental practices in Northern Ireland were invited to participate, 28 refused (response rate = 97%). Patients were randomised into two groups. The experimental group received a PIL and then completed a self-report questionnaire, whereas the control group followed same procedure without the PIL. Measures included a 36 item oral cancer knowledge scale and two items to assess risk perception. Usable data were available from 944 patients; mean (SD) age = 42 (15), 65% female. Risk perceptions of oral cancer were minimally effected by the PIL (p = 0.023). This effect was demonstrable in smokers. Smokers were sixteen (95% CI: 8-30) times more likely to believe that they were at greater risk of oral cancer than non-smokers. A clear benefit of the PIL on patients' oral cancer knowledge was found, particularly for smokers and those with a history of smoking. These findings demonstrate that public awareness of smokers can be raised with written information although health beliefs such as risk perceptions require more intensive intervention.

The association of cigarette smoking and anxiety, depression and fears of recurrence in patients following treatment of oral and oropharyngeal malignancy

Psychological factors, including distress and fears of recurrence, may be implicated in explaining why head and neck oncology patients continue or refrain from smoking. The aim was to determine the role of psychological factors in understanding smoking behaviour in a consecutive group of cancer patients attending a Regional Maxillofacial Unit over an assessment period of 12 months. A consecutive sample (n = 87) was assessed at 3, 7, 11 and 15 months following initial treatment. Measures of psychological distress included the Worry of Cancer Scale and the Hospital Anxiety and Depression Scale. Patient self-report assessed tobacco consumption. At follow-up, 73 patients successfully completed the four timed assessments (84% response rate). Twenty patients were consistent smokers (27%), 37 (51%) abstained, 7 (10%) returned to smoking, whereas 9 (12%) ceased to smoke by the final 15-month follow-up. Between the consistent smokers and abstainers there was a significant raised level of distress in the smoking group at each assessment after the initial baseline. Fear of recurrence was weakly related to smoking behaviour. The level of cigarette consumption at baseline was a significant predictor (adjust r (2) = 0.37) of psychological distress at 15 months in committed smokers. Previous duration of tobacco consumption prior to illness predicted psychological distress in abstainers (standardized coefficient = 0.29, n = 30, P < 0.036). In conclusion, past and current smoking behaviour is associated with psychological distress in patients with oral and oropharyngeal malignancy in their first 15 months of recovery following initial treatment. This behaviour successfully identified a psychologically at-risk group.

An oral cancer information leaflet for smokers in primary care: results from two randomised controlled trials

OBJECTIVES

To investigate whether primary care patients who claim to smoke tobacco gain greater benefit of a patient information leaflet (PIL) on oral cancer than nonsmokers.

METHODS

Two studies were conducted. Study 1 examined the research question initially, and Study 2 acted as a replication and inclusion of additional secondary outcome measures. The leaflet was designed and tested in an earlier study. Knowledge of oral cancer was assessed by a previously validated 36-dichotomous-item scale. A single-item question ascertained self-reported smoking status (kappa = 0.94). Study 1 participants were drawn from 14 practices (6 medical, 8 dental). A randomised control group design was adopted. The experimental group received the leaflet on attendance to the practice and then completed the questionnaire. The control group received the questionnaire only. Complete data were collected from 739 respondents. The design of Study 2 was identical; 786 new respondents from 16 practices (7 medical, 9 dental) were collected.

RESULTS

Both studies confirmed that smokers knew less about oral cancer than nonsmokers (P < 0.05) when access to the leaflet had been denied. On receipt of the leaflet, there was no distinction in oral cancer knowledge between the smoking status categories of respondents. Evidence of reassurance about screening from leaflet exposure was supported by the second study.

CONCLUSION

This programmed research has demonstrated an effect of a brief PIL to offset the decrement in oral cancer knowledge observed in primary care patients who use tobacco in comparison to their nonsmoking counterparts. The leaflet reduced anxiety about oral health screening in smokers.

Assessment of reading level and content adequacy of oral cancer educational materials from USAF dental clinics

BACKGROUND

The threat of oral cancer has generated growing concern among the military health community that its beneficiaries have access to appropriate printed health materials. This study addresses the reading level and content adequacy of printed oral cancer literature collected from 82 United States Air Force (USAF) dental clinics.

METHODS

Materials were subjected to a readability formula and information content analysis.

RESULTS

Readability ranged from 7th to 13th grade, consistent with the lowest grade level (high school) required for USAF personnel. Adequacy of the content of materials was highly variable.

CONCLUSION

Few oral cancer items were retrieved, most were old, and many included misleading or incorrect information.

Oral cancer information in health education textbooks

BACKGROUND

Previous studies have reported a lack of knowledge and misinformation about oral cancer, its risk factors, and preventive methods among the general public. This study evaluated the quality, completeness, and accuracy of oral cancer information in 26 health education (elementary to high school) textbooks.

METHODS

Twenty-six health education textbooks were purchased and evaluated.

RESULTS

A deficiency in the amount, accuracy, and quality of oral cancer information in grade school and high school textbooks was evident.

CONCLUSION

Current health texts do not provide adequate information to educate future adults about oral cancer prevention and early detection.

Coverage and quality of oral cancer information in selected popular press: May 1998 to July 2003

OBJECTIVES

A 1998 study demonstrated a lack of coverage about oral cancer in the popular press between April 1987 and April 1997. Since that study, several oral cancer-related activities took place, many of which could have increased the media's attention to oral cancer. Therefore, this study analyzed coverage and quality of oral cancer information in selected popular press between May 1998 and July 2003.

METHODS

Articles from magazines and newspapers were retrieved from three databases and were analyzed by specific topics and subtopics for adequacy of content and accuracy of information. Articles were categorized as either "primarily oral cancer-related" or "primarily tobacco-related."

RESULTS

Sixty articles were identified, 39 of which were included in the analysis (14 magazines; 25 newspapers). Seventeen articles were "primarily oral cancer-related," and 22 were "primarily tobacco-related." Seventy-two percent of the articles mentioned at least one risk factor for oral cancer, the most common being tobacco use (69%). Far fewer articles noted alcohol (10%) or the combined use of tobacco and alcohol (5%) as risk factors. Only 8 percent of the articles recommended an oral cancer examination.

CONCLUSION

Despite local and limited national efforts and activities aimed at increasing public awareness of oral cancer, the popular press coverage of those activities was minimal or nonexistent.

Comunicação instrumental, diretiva e afetiva em impressos hospitalares

Este trabalho se ocupa dos típicos sistemas semânticos extraídos dos recursos comunicativos de equipes hospitalares, que tentam validar informações como um "objeto" a ser transferido aos pacientes. Descrevemos modelos de comunicação textual em 58 impressos de orientações aos pacientes de cinco unidades hospitalares, coletados de 1996 a 2002. Identificamos três categorias fundamentadas na teoria dos atos de fala (Austin, Searle e Habermas): (1) Proferimentos cognitivo-instrumentais - descrições por meio de termos técnicos validados por argumentação auto-referente, incompleta ou inacessível; função educativa implícita. (2) Proferimentos técnico-diretivos - auto-referentes (contexto dos setores de origem); deslocamento freqüente de atos cotidianos para o terreno técnico com função disciplinadora; impessoalidade. (3) Modulações expressivas: necessidade de conexões intersubjetivas para fortalecer laços de confiança; tendência à infantilização. Concluímos que as categorias estudadas expõem: base em origens fragmentárias; pressupostos de univocidade de mensagens e consumo invariante da informação (motivações e interesses idealizados, alheios às perspectivas individuais); pressuposto de interesses universais como geradores de conhecimento.

[Communication prostheses and behavioral alignment in hospital leaflets]

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

The immediate effect on knowledge, attitudes and intentions in primary care attenders of a patient information leaflet: a randomized control trial replication and extension

AIM

To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen.

DESIGN

Randomized controlled trial.

SETTING

Dental and medical waiting rooms in the North West of England.

SAMPLE

Nine hundred and forty nine patients from 16 practices were invited to participate.

MEASURES

Standardized multi-item scales of six outcome measures including knowledge, beliefs and intention to accept an oral cancer screen.

PROCEDURE

A patient information leaflet was given to a randomized intervention group of patients. A single sheet questionnaire was completed by both groups of patients (immediately following leaflet administration in the intervention arm of study).

STATISTICAL ANALYSIS

t tests were used to compare outcome variables between patients with and without access to the leaflet with Boneferroni correction.

RESULTS

Participation rate was high (91%). Knowledge (P <0.001) and intentions (P = 0.003) benefited from patient access to leaflet. Anxiety was not raised with leaflet exposure. Some beliefs about the screening procedure appeared to be slightly improved by reading the leaflet (p <0.05).

CONCLUSION

This study supports previous findings of an immediate positive effect of an information leaflet on patients' knowledge of oral cancer and willingness to accept an oral cancer screen.

Need for appropriate written information for patients, with particular reference to head and neck cancer

Patients need and want written information. There is evidence that giving comprehensible information increases overall satisfaction with the care given by healthcare professionals. This paper provides a review of the literature on patients' need for appropriate information, with particular reference to head and neck cancer, based on searches of electronic databases. Head and neck cancers are among the least common cancers in the UK but these patients have very specific and great needs. Written information is a cost-effective intervention that complements verbal advice given by healthcare professionals. Evidence suggests that patient information leaflets are poor and are in language that is difficult for the public to understand. Considerable time, effort and user involvement are required to produce acceptable and appropriate information leaflets for patients.

Maryland adults' perspectives on oral cancer prevention and early detection

OVERVIEW

In any given 12-month period, Maryland ranks 27th among all states and the District of Columbia in estimated new cases of oral cancer. The state also has the seventh highest overall mortality rate for oral cancer. Because of earlier research indicating that Maryland adults had little knowledge and many misconceptions about oral cancer, the authors undertook a study to obtain in-depth information from Maryland adults 40 years of age or older on oral cancer, oral cancer examinations and factors associated with having an oral cancer examination.

METHODS

The authors conducted a qualitative descriptive study using information gathered from three focus groups consisting of nine, 10 and seven adults respectively, and which met at two locations. The authors hired a private focus group research firm, which randomly selected participants from a telephone list of local residents. A professionally trained moderator conducted all focus groups using a semistructured interview guide.

RESULTS

Participants were struck by the fact that they rarely hear about this type of cancer. Many said that they never had had an oral cancer examination and did not know there was such a thing. Many participants also reported that they likely would be more comfortable discussing oral cancer with their physicians than with their dentists.

CONCLUSIONS

These findings provide additional in-depth insights to earlier work about Maryland adults' oral cancer knowledge, opinions and practices. The state plans to use this information to develop educational materials and interventions for the public to promote oral cancer prevention and early detection in Maryland.

CLINICAL IMPLICATIONS

Extensive public education about oral and pharyngeal cancers should be provided in dental offices and clinics, as well as in mass media of all types. More clinicians should include comprehensive oral cancer screenings in their oral examinations, and they should explain to patients what they are doing when they provide these screenings.