E. Teng1, M. Abraham1, J. Lever1, L. Gutnik1, C. Parker1, R. Lancaster1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction:
Access to reliable health information is essential for improved patient autonomy, surgical outcomes, informed decision-making, and satisfaction. Educational handouts provided by clinics are a valuable adjunct to provider interactions for understanding complex medical information. Patient education materials (PEMs) on breast cancer generally exceed the nationally recommended sixth grade reading level, and surgical materials are especially difficult to understand, with pronounced effects on patients with low health literacy (HL). We developed and evaluated a new print PEM on breast cancer to address the disparity between patient HL levels and education materials.
Methods:
Members of the breast surgery team worked with patient navigators and marketing professionals to design and refine a new PEM on navigating breast cancer diagnoses, treatments, and surgical options. The material integrated patient feedback, CARP visual design (foundational design principles such as contrast and repetition), readability, and HL guidelines. The new PEM replaced an existing handout previously provided to newly diagnosed breast cancer patients at a comprehensive breast health clinic within a tertiary academic medical center. Reading level of the previous and new PEMs were measured across four different readability metrics and results were analyzed with a nonparametric Mann-Whitney U test for statistical significance. Fifteen patients with a prior diagnosis of breast cancer who presented for follow-up visits in July 2024 were surveyed. We used the Brief Health Literacy Screening Tool (BRIEF) to assess baseline health literacy. Respondents then reviewed the previous and new materials in a pilot survey with Likert scale statements and open-ended questions evaluating preference and understandability. Quantitative results were analyzed using a two-way ANOVA and Bonferroni test in GraphPad Prism.
Results:
The new education material had an improved readability to the nationally recommended sixth grade level, compared to the prior material's ninth grade reading level (p=0.029). Fifteen patients completed the BRIEF screen, with an average adequate HL score of 17.93; 27% had marginal HL and 73% had adequate. Patients rated the new material as more attention-catching, readable, understandable, relevant, and organized than the prior material using the Likert scale statements (p<0.0001). Common qualitative response themes included improved diagrams (72%), color (45%), and organization (36%) in the new material.
Conclusion:
A health literacy-focused design process for patient education materials can improve understandability of breast cancer information, with potential downstream benefits to patient autonomy and informed surgical decision-making. Continued effort is needed to better assess patient understanding of the new education materials beyond this pilot survey and to further improve accessibility and utilization of quality breast cancer education materials.