M. N. Abraham1, C. Moses1, P. Abraham1, C. Parker1, R. Lancaster1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Low health literacy is associated with decreased screening, more frequent hospitalizations, and increased use of emergency care, while higher levels of education and engagement have been shown to improve outcomes. Health literacy (HL) is particularly important in breast cancer care as patients are required to understand complex medical information in order to participate in shared decision making. Thus, low HL may have significant implications for patient satisfaction, autonomy, and outcomes. We aimed to study the health literacy of our patient population using a mixed methods approach.
Methods: The Brief Health Literacy Screening Tool (BRIEF) was administered to patients presenting with a new diagnosis of breast cancer at a comprehensive breast health clinic within a tertiary academic medical center from September 2022 to June 2023. We simultaneously conducted a qualitative study utilizing semi-structured interviews to evaluate patients’ understanding of their diagnosis. A combination of random and purposive sampling was used to enroll patients in the qualitative study based on the results of their BRIEF screen, aiming to capture a representative sample. Interviews were recorded, transcribed, and coded by two independent reviewers using NVivo. Themes were identified using a grounded theory approach.
Results: Two hundred eighty-two patients completed the BRIEF out of 490 total new breast cancer patients who presented during this time frame (response rate = 57.5%). The average score was 17.45, with 33 (11.7%) patients having inadequate HL, 45 (15.9%) having marginal HL, and 204 (72.3%) having adequate HL based on cutoffs shown in Table 1. Of the 30 patients who participated in qualitative interviews, the average BRIEF score was 16.6. Patients in the adequate HL group (N=18) had higher levels of understanding of their diagnosis, often stating details of their pathology, staging, and prognosis. However, 3 of the patients (17%) screened into the adequate HL group had no knowledge of their diagnosis. 13 of 18 (72%) patients in the adequate HL group did research into their cancer diagnosis prior to their clinic visit, compared to only 3 of 12 (25%) patients in the low HL group. Patients in both groups expressed anxiety and nervousness about their new cancer diagnosis, and faith was identified as an important component of emotional well-being in both groups.
Conclusion: We found that almost 30% of patients presenting with a new diagnosis of breast cancer had marginal-inadequate health literacy and would stand to benefit from additional educational interventions. Further work is needed to evaluate patient knowledge and experience following education and treatment in order to improve the experience for future patients.
