02.01 The Role of Conversation and Health Literacy in Patient-Surgeon Telehealth Encounters

E. Lopez1, L. Wood1, I. Marques1, L. Theiss1, C. Shao1, R. Hollis1, J. Cannon1, M. Morris1, D. Gunnells1, G. Kennedy1, K. Hardiman1, D. Chu1 1University Of Alabama at Birmingham,Birmingham, Alabama, USA

Introduction: Patients with limited health literacy have difficulty understanding health information, which may lead to worse health outcomes. As telehealth use increases in surgery, especially as a response to COVID-19, communication increasingly relies on conversation. It is unclear, however, if variations exist in these conversations that may be amenable to improvement. This study aimed to understand the relationship between patient and physician speech on understandability in patient-surgeon telehealth encounters.

Methods: New and returning telehealth surgical patients for six surgeons at the UAB Colorectal Clinic (June-July 2020) were recruited and consented. Health literacy was measured using the Brief Health Literacy Screening Tool (BRIEF). Patient-surgeon conversations were audio-recorded during telehealth visits. Recordings were transcribed and analyzed for questions asked, length of visit (LOV), and understandability of words by the Flesch-Kincaid Ease Score (FKES), Flesh Kincaid Grade Level (FKGL), Gunning-Fog Index (GFI), Coleman-Lau Index (CLI), and Simple Measure of Gobbledygook (SMOG). 

Results:Twenty-four patients were enrolled. The mean age was 49.5 years (+/- 12.7) and 66.7% were female. Health literacy levels were adequate (11 patients, 45.8%), marginal (10 patients, 41.7%) and low (3 patient, 12.5%). Speech between surgeons varied by understandability and LOV. Overall average LOV was 10 minutes and 3 seconds (+/- 6 minutes and 40 seconds) among all surgeons (N=24). Overall average SMOG score was 5.2 (+/-1.2) and overall average FKES was 84.3 (+/-6). Lower understandability was associated with longer LOV (p<0.0003), longer physician speaking time (p<0.0003), and more words spoken by physician (p<0.0009). However, higher percentage words spoken by patient was associated with higher understandability (p<0.01).

Conclusion:Length of visit and understandability vary among surgeon speech during patient-surgeon telehealth encounters. Longer physician speaking time is significantly associated with less understandable words while more speaking time for patients is associated with more understandable encounters. Creating an environment where patients with low health literacy are able to speak more and ask more questions may help improve patient understanding.