An informed consent document may be too complex for a patient to interpret; as a result, the patient may make suboptimal decisions about accepting or declining interventions. A patient may be provided with information but not understand how to weigh risks and benefits, make decisions, and ultimately take action. Every patient is unique, and nurses should not automatically assume the information given is understood, even if the patients look over the written information and state that they do understand it.

Table 1. Red flags a patient may have low health literacy

Asks fewer questions
Identifies medications by appearance rather than by label information
Inability to name medications, explain their purpose, or give the dosage
Inability to provide a coherent, sequential medical history
Lack of adherence to treatment protocol
Lack of follow-though with tests and referrals
Patient frequently misses appointments
Registration forms are incomplete

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Health literacy awareness among clinicians should be promoted and literacy screenings utilized to ensure no patient is left behind (Table 1). Information must be tailored to meet the needs and abilities of the patient and ensure they have the skills to comprehend it and make collaborative decisions with their clinicians. Strategies need to account for differing experiences, abilities, knowledge, cultural beliefs, practices, and communication skills. Areas associated with health literacy include, but are not limited to, the following.

  • Communication between the patient & clinician
  • Medical instructions, drug labeling interpretation and adherence
  • Patient education material and resources
  • Evaluation of information for credibility
  • Informed consent
  • Interpretation of test results
  • Medical and insurance forms
  • Analysis of relative risks and benefits
  • Provision of accurate and relevant patient history

Questions to consider …

What basic information must a patient know that will be useful for them to make an informed decision?

Do your patients know where and how to access credible information that is easy to understand?

Is reinforcement of the education throughout the journey part of your strategy?

Does timing of the delivery of education play a role in adequate self-management and adherence?

Have clinicians delivering education been trained on health literacy?

Do you use tools designed to assess the literacy level of your patients?

Improvements in health literacy have been linked to extended longevity; improved quality of life, patient safety, and patient outcomes; reduced prevalence of chronic disease, health disparities, and medical errors; and lowered health care-related costs. Do you have strategies and tactics in place to ensure your patients understand the information you convey to them? A few simple techniques can be incorporated into the patient-nurse interaction to pave the path towards success.

  • Focus on what patients need to know and need to do in three to five key points
  • Repeat and summarize messages
  • Use the teach-back method, in which the patient explains your instructions back to you in their own words, to confirm the patient’s understanding
  • Use visuals to improve understanding and recall, use plain language that you would use when speaking with a friend.

The health care team should take active steps toward enabling patients to become empowered as an equal partner in care. Ultimately, a future with improved outcomes is contingent on the evolution of the role of the patient. What strategies have you adopted to minimize barriers and misunderstanding as you educate your patients? ONA 

Sarah Krug is CEO of, an organization that empowers patients and caregivers to take control over their diagnoses, navigate the cancer journey, and partner with their healthcare team to make informed decisions through a variety of tools and resources.  


1. Institute of Medicine Committee on Health Literacy. Health literacy: A prescription to end confusion. Accessed October 23, 2013.