Health Literacy Video Analysis

Previous studies have suggested that African Americans are more likely to prefer aggressive end-of-life (EOL) care. However, the relationship of low health literacy on EOL decision-making has not been investigated. The researchers hypothesized that health literacy, not race, would predict preferences for care at EOL. They also hypothesized that a video of a patient with advanced dementia would overcome communication barriers associated with low health literacy. A total of 144 subjects participated in the study, 80 African Americans and 64 whites. They were all over the age of 40 years and were drawn from six study sites at urban and suburban primary care clinics in the greater Boston area. Two white, male physicians conducted interviews between

The same verbal description of advanced dementia accompanied the video. At the conclusion of the video, each participant was asked the same question regarding preferences for level of care. Finally, health literacy was measured using the validated Rapid Estimate of Adult Literacy in Medicine (REALM) tool and three categories of health literacy were defined: low literacy; marginal literacy; and adequate literacy. Race, health literacy level, and preference for care after hearing a verbal description of advanced dementia were compared to preference for care after viewing the video. After verbal description of advanced dementia, African Americans were more likely to have preferences for aggressive care than whites. Also, preferences after the verbal description were strongly associated with health literacy. Participants with low health literacy were more likely to have preferences for aggressive care compared to participants with adequate health literacy. However, after the participants viewed the video, their preferences were statistically significant different (p<0.0001) than after hearing the verbal description: no whites and only 13% of African Americans preferred aggressive