Are radiation oncologists aware of health literacy amongst people with cancer treated with radiotherapy? — ASN Events
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Are radiation oncologists aware of health literacy amongst people with cancer treated with radiotherapy? (#764)

Sian Smith 1 , Lisa-Marie Petrak 2 , Jennifer Taylor 2 , Chris Milross 2 3 , Haryana M Dhillon 2 4
  1. Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia
  2. University of Sydney, Sydney, NSW, Australia
  3. Sydney Cancer Centre, Dept Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  4. Psycho-Oncology Cooperative Research Group, University of Sydney, NSW, Australia

Background:  Patients with cancer are exposed to complex information as part of treatment decision-making. There has been little research with cancer patients who have lower education and literacy, or the clinicians caring for them and their awareness of health literacy. This study aims to gain insight into radiation oncologist’s (RO) awareness of health literacy amongst their patients, and its effect on communication and decision-making.

Methods:  This qualitative study used semi-structured interviews with ROs conducted in person or via telephone.  Interviews were audio-recorded and transcribed verbatim.  Framework analysis was used to develop a coding schema of themes identified from the interviews. The coding schema was then used to code, chart and analyse the data and compare and contrast how ROs experiences differ. 

Findings:  Twenty-six ROs, aged  35-65 years and who had worked in oncology for 9 to 30 years, were interviewed. Nineteen were male, 17 Australian and 18 native English speakers.

Main themes identified included: recognition of need to screen patients for characteristics indicating lower literacy levels; using  verbal and visual information is important to effective communication; using the multi-disciplinary team to communicate with and support patients; tailoring consultations to meet expectations, needs and preferences of patients; confirming patient understanding.

ROs described strategies to help them form judgments about  patients literacy level. These included; monitoring questions asked, vocabulary used, non-verbal behaviour and demographic information. Only a few ROs indicated they would screen patient literacy levels and one reported using a screening tool in practice. Most identified concepts they perceived patients had difficulty understanding, including: disease and treatment information; risk information; side-effects of treatment; the healthcare system. ROs reported difficulties discussing subtleties of cancer treatments with patients they thought had lower literacy.

Discussion: RO recognised health literacy as important in patient decision-making, adherence and self-care in radiotherapy.  There are opportunities to improve communication between RO and patients, including: improved literacy screening tools, improved information materials about cancer and radiotherapy, and increasing communication skills of health professionals in dealing with patients of limited literacy.