Tool developed to identify patients with limited cancer health literacy

Researchers have developed the first and only tool that can accurately measure cancer health literacy (CHL) and quickly identify patients with limited CHL. This tool has the potential to improve communication and understanding between clinicians and patients, which, in turn, could lead to better clinical outcomes.

Recently published in the Journal of Health Communications (2014; doi:10.1080/10810730.2014.943377), the Cancer Health Literacy Study was conducted over 4 years and involved 1,306 African American and white patients from Massey Cancer Center at Virginia Commonwealth University (VCU) and surrounding oncology clinics. The researchers developed an evaluation tool called the Cancer Health Literacy Test (CHLT)-30 to measure cancer health literacy along a continuum.

The test, which was administered to the patients via a touch-screen device, asked 30 questions about cancer treatment, medication side effects, and more. Six of the 30 questions (CHLT-6) were specifically designed to quickly identify patients with limited CHL.

Together, the tests accurately measured CHL and quickly identified patients with limited CHL. The study reported that 18% of patients with cancer have limited cancer health literacy, with an overrepresentation of African American, undereducated, and low-income patients.

"Using this tool, it takes just 1 to 2 minutes in the doctor's office waiting room to identify patients with limited CHL. Then this information can be digitally communicated to the doctors prior to seeing the patients, so that they are prepared to talk with the patients in terms they can understand," said lead researcher Levent Dumenci, PhD, member of the Cancer Prevention and Control research program at Massey and professor in the Department of Social and Behavioral Health at the VCU School of Medicine. "This simple change could lead to big improvements in health outcomes."

Health literacy is the degree to which a person has the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

"Before now, there were only instruments that measured a particular aspect of general health literacy. It is important to have a tool that is specific to cancer because of the complex treatment options that cancer patients face, along with the increased demand for self-care," said Dumenci.

The demand for increased self-care was emphasized in the Affordable Care Act, where federal and state policymakers embraced patient engagement as a key strategy in addressing health care costs and improving quality of care.

Patients are expected to play an active role in their health care by successfully adhering to medication regimens; distinguishing between scientifically credible medical evidence and misconceptions or myths; and effectively communicating with their providers on treatment decisions, risks, and survival rates. Patients with limited cancer health literacy can struggle with these responsibilities and potentially jeopardize their health outcomes by making uninformed decisions, mishandling medications and more.

In future studies, the researchers hope to evaluate the CHL of Hispanic patients because prior research has indicated disparities in that population's health literacy. To do so, the CHL test will need to be translated into Spanish to remove the language barrier.

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