Oncology Nurses Are Key to Patient Literacy But They Need Support

General literacy is widely understood as an important skill that must be prioritized to ensure that people can live healthy and successful lives. In our medical field we also have patient literacy, also known as health literacy, which is defined by the CDC as the “degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” 

Patient literacy is just as important as overall literacy but it is not equally prioritized. According to the U.S. Department of Health and Human Services, just 12 percent of Americans possess patient literacy at a level that would be considered adequate. This has damaging and costly impacts to patients, healthcare organizations, and society overall.

In addition to its overall importance, patient literacy is especially important in oncology due to how complex, intensive, and information-heavy cancer treatment can be. Low levels of patient literacy among cancer patients result in poor health outcomes, higher medical costs, and lower patient satisfaction. On the other hand, higher patient literacy among cancer patients leads to better treatment outcomes, lower costs, and higher patient satisfaction. Clearly, most healthcare organizations would prefer that their patients have higher levels of health literacy. But what are the barriers that stand in the way and how can these barriers be addressed?

The critical role that nurses play

It probably comes as no surprise to anyone that nurses play an important role in health literacy for cancer patients. Nurses spend more time with patients than physicians, and for oncology nurses this is true not just on a daily basis but also in terms of the overall period of treatment since in many cases cancer becomes a chronic, long-term condition. Partly because of how much time they spend with cancer patients, but also because of the vulnerability and gratitude that cancer patients often express, oncology nurses tend to experience deeper feelings of meaning and connection with their patients. The time and special connection that oncology nurses share with their patients inevitably puts them in a position to play an important role for patient literacy.

However, there are some common barriers that make it more challenging for nurses, both in general and for oncology nurses specifically, to advocate for patient literacy as effectively as possible. One is that despite having a high level of medical knowledge, not all nurses have all the skills needed to fully promote health literacy. For example, they might lack the ability to assess the health literacy levels of their patients or they might make assumptions and overestimate their patients’ health literacy levels.

Another barrier is the lack of cultural competence which is an entire problem of its own but is related to patient literacy as well. Cultural competence is the ability to recognize different cultures and their diverse beliefs, perspectives, experiences, and traditions. It is also the ability to understand the importance of language and to adapt to people’s different levels of English proficiency. The need for cultural competence is especially great when working with patients from medically underserved populations since many of them may not be native English speakers. A high percentage of oncology nurses face communication challenges with patients who speak English as a second language, and they are not always able to recognize signs of low health literacy in those patients. 

Remedies to the problems

One way to address these challenges is to integrate skills related to assessing and promoting health literacy into nurse training and education. It is not common for nurses to currently receive patient literacy training in nursing schools. Even though nursing program curriculums are already packed with content, adding health literacy training doesn’t require making dramatic changes to existing programs. It can be as simple as adding a class or two, and as little as four hours of content have been shown to improve nursing students’ knowledge and awareness of patient literacy. 

As mentioned, nurses are in a natural position to advocate for patient literacy because of how much time they spend with patients. However, the responsibility to promote patient literacy should not rest only on nurses’ shoulders. Nurses already bear a significant amount of care burden, and oncology nurses in particular deal with the additional psychological burden of caring for dying patients which contributes to high rates of burnout and turnover. 

The responsibility of patient literacy should be shared across the entire healthcare staff to not only ensure a fairer distribution of labor but to promote the highest level of patient literacy possible. Fortunately, just as with nurses, a little bit of investment in this area goes a long way. Research shows that even just one training intervention on patient literacy improved patient literacy awareness and skills among both physicians and general healthcare staff. The use of dedicated patient navigators in many hospitals is another promising way to distribute some of the responsibility for boosting patient literacy. 

Technology can also play a role. At this point, there are risks to using AI for patient literacy due to the potential for inaccurate information. But as the technology becomes more accurate and affordable, using AI as a resource for patient literacy has a lot of potential. For example, hospitals could be equipped with terminals where AI chatbots can assess patients’ health literacy levels and provide basic information. It would not be for replacing the in-person guidance that nurses and other healthcare professionals provide but to serve as a helpful supplement. Even something as simple as a TV channel dedicated to boosting patient literacy can be easily integrated into existing infrastructure and be very helpful in healthcare settings that don’t already have this in place. 

In general, whether it’s a dedicated TV channel, an AI chatbot, or the traditional printed material, all information provided to patients should have a “universal precautions” approach. This means using plain and everyday language in both the written and spoken forms. It also means using plenty of images and graphics instead of relying too much on text. Finally, healthcare staff should never make assumptions about a patient’s level of health literacy based on external appearances or qualifications such as their educational level or current occupation because these things can be deceiving.

Changing any status quo is challenging, but maintaining the status quo of low patient literacy in healthcare is costly and detrimental to both patients and healthcare organizations. Investing in patient literacy is therefore investing in healthcare itself. And, as the research shows, even small changes such as workshops for nurses, physicians, and healthcare staff can lead to improved outcomes for patient literacy.

Photo: Hiraman, Getty Images

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.