Conquering low health literacy among your patients

Oncology nurses can improve communication with—and outcomes of—their elderly cancer patients by overcoming barriers to health literacy among these patients. 

As noted in a poster presented at the 36th Annual Congress of the Oncology Nursing Society, held April 28-May 1 in Boston, Massachusetts, the Institute of Medicine defines health literacy as the degree to which a person can obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low health literacy is prevalent among older adults: In the 2003 National Assessment of Health Literacy (, 59% of persons older than 65 years scored at the basic or below-basic levels of health literacy.

However, several simple and effective screening tools are readily available to help nurses gauge and address the health literacy of their older patients, according to poster presenters Ellen C. Mullen, RN, ANP-BC, GNP-BC, and Daniel Mullen, RN, BSN, of the University of Texas M. D. Anderson Cancer Center in Houston. For example, the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Newest Vital Signs assessment take only about 3 minutes to administer; the Test of Functional Health Literacy in Adults (TOFHLA) takes can be administered in about 7 minutes.

Once literacy is assessed, nurses can then tailor their oral and written communications with the patient to match the patient's level of understanding. The poster offered several tips for working with patients with low literacy:

  • Develop written materials below fifth-grade reading levels.
  • Keep content and format simple, using shorter words and sentences.
  • Use larger, bold-face or underlined fonts with well-spaced lines,
  • Have a magnifying glass and good lighting available when reviewing these materials with the patient.
  • Be sure the patient has his or her reading glasses, hearing aids, or other assistive devices he or she will need to best review the materials.
  • Involve the patient's significant other or caregiver in the discussion.

Nurses can also refer patients to trusted online resources for medical information and to community programs that help improve health literacy levels.

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