Patients experience better outcomes when they are more informed and engaged in their care. But many healthcare providers overestimate their patients’ health literacy levels, which can impede the process.

A team of researchers set out to assess the feasibility and acceptability of a nurse-led SMART educational intervention on the improvement of outcomes in adult patients with cancer. (SMART stands for specific, measurable, achievable, realistic, and timely.) Their findings were published in Oncology Nursing Forum.

The researchers used a mixed-methods study design and recruited 68 adult patients with cancer from an oncology research center in Scottsdale, Arizona. Registered nurses in the clinic interested in administering the intervention received education and training on the SMART intervention prior to the study.

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Patients were randomly assigned to a waitlist control group or an immediate intervention group. The intervention group immediately began the education intervention; modules focused on topics such as nutrition, anxiety and coping, sleep and fatigue, and individualized medication review. During the intervention, patients were asked to choose goals when they received new information, and wrote up the goals using the SMART format. They created action plans to identify steps toward achieving their goals. The nurses conducted follow-up visits by phone or in person after the educational intervention visits and helped the patients review their progress.

The nurses also assessed the patients’ health literacy and empowerment with the Cancer Health Literacy Test (CHLT-30). Patients eventually completed the Adapted Short Assessment of Patient Satisfaction.

One limitation of the study was that only 40 of the 68 patients completed it. Both the clinic population and study sample were limited in diversity, which limits the generalizability of the researchers’ findings.

However, many of the patients who did finish the study indicated they were satisfied with the intervention. Some important lessons gleaned from the study can help shape the way education is provided in the future. For example, sometimes the amount of new information overwhelmed the patient and they were unable to process everything at that time or needed to revisit a prior module topic, the researchers explained.

But these study findings show that a nurse-led intervention can make a difference in terms of providing patients with the information they need to make informed health decisions and improve their outcomes. Nurses must be prepared to regularly assess their patients’ knowledge attainment and retention of information along the way. Organizations also have to commit to training and education for their nursing staff to be able to provide this type of intervention, the researchers stated.

“Education provided using SMART goals, an engaging format, and an individualized process with a universal approach to health literacy creates a solid foundation for patients’ well-being,” the researchers concluded. “Once literacy is addressed, patients can begin to work on achieving their health-related goals.”

Disclosures:  The research was supported by the DAISY Foundation.


Mirabella A, Vrana A, Bay RC, Slater A, Brewer MA. SMART oncology nursing: literacy, goals, coaching, and empowerment. Oncol Nurs Forum. 2022;49(1):37-45. doi:10.1188/22.ONF.37-45