Health literacy and cancer self-management behaviors: A scoping review

Readability of Patient Education Materials in Head and Neck Cancer: A Systematic Review

Importance

Patient education materials (PEMs) can promote patient engagement, satisfaction, and treatment adherence. The American Medical Association recommends that PEMs be developed for a sixth-grade or lower reading level. Health literacy (HL) refers to an individual's ability to seek, understand, and use health information to make appropriate decisions regarding their health. Patients with suboptimal HL may not be able to understand or act on health information and are at risk for adverse health outcomes.

Objective

To assess the readability of PEMs on head and neck cancer (HNC) and to evaluate HL among patients with HNC.

Evidence Review

A systematic review of the literature was performed by searching Cochrane, PubMed, and Scopus for peer-reviewed studies published from 1995 to 2024 using the keywords head and neck cancer, readability, health literacy, and related synonyms. Full-text studies in English that evaluated readability and/or HL measures were included. Readability assessments included the Flesch-Kincaid Grade Level (FKGL grade, 0-20, with higher grades indicating greater reading difficulty) and Flesch Reading Ease (FRE score, 1-100, with higher scores indicating easier readability), among others. Reviews, conference materials, opinion letters, and guidelines were excluded. Study quality was assessed using the Appraisal Tool for Cross-Sectional Studies.

Findings

Of the 3235 studies identified, 17 studies assessing the readability of 1124 HNC PEMs produced by professional societies, hospitals, and others were included. The mean FKGL grade ranged from 8.8 to 14.8; none of the studies reported a mean FKGL of grade 6 or lower. Eight studies assessed HL and found inadequate HL prevalence ranging from 11.9% to 47.0%.

Conclusions and Relevance

These findings indicate that more than one-third of patients with HNC demonstrate inadequate HL, yet none of the PEMs assessed were developed for a sixth grade or lower reading level, as recommended by the American Medical Association. This incongruence highlights the need to address the readability of HNC PEMs to improve patient understanding of the disease and to mitigate potential barriers to shared decision-making for patients with HNC. It is crucial to acknowledge the responsibility of health care professionals to produce and promote more effective PEMs to dismantle the potentially preventable literacy barriers.

Personal and organisational health literacy in the non-specific symptom pathway for cancer: An ethnographic study

INTRODUCTION

People being investigated for cancer face a wealth of complex information. Non-specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner 'gut feeling', who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways.

METHODS

This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowing and clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy.

RESULTS

Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge.

CONCLUSION

We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help-seeking post-discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtesting or inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors.

PATIENT OR PUBLIC CONTRIBUTION

Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.-A. M.) was involved in data analysis and writing the manuscript.

Association between eHealth literacy and health outcomes in German athletes using the GR-eHEALS questionnaire: a validation and outcome study

BACKGROUND

Athletes face various sports-related stressors, which may increase their risk for physical and mental health symptoms. With the internet as an important source of (health) information, it is important for athletes to have eHealth literacy, i.e. the ability to access, understand and use electronic health information and services. However, it is presently uncertain whether eHealth literacy of athletes is linked to better health outcomes such as reduced injury frequency and behaviours like decreased substance abuse.

METHODS

A cross-sectional study was conducted with N = 373 German athletes (229 females) from different types of sport (e.g., ball sports and water sports) who were included in the statistical analyses. The survey included medical, socio-demographic, eHealth- and sports-related data as well as the eHealth Literacy Scale (GR-eHEALS) questionnaire, which measures eHealth literacy. Confirmatory factor analyses and correlational analyses were performed to determine the convergent and discriminant (compared to the 8-item Impulsive Behavior-8 Scale) validity of the GR-eHEALS and to assess the relation between eHealth literacy scores and health outcomes.

RESULTS

The more frequently athletes had sustained minor or moderate injuries in the past, the higher the level of eHealth literacy they reported. Furthermore, consumption frequency of painkillers (r = .18, p = .002), sedatives (r = .12, p = .040), and cannabis (r = .29, p = .000) was significantly correlated with eHealth literacy scores. The confirmatory factor analysis of the GR-eHEALS showed an acceptable model fit with a 2-factor solution (information seeking and information appraisal). The GR-eHEALS showed good discriminant (r = - .09, p = .21) and convergent validity (digital confidence; r = .28, p < .001).

CONCLUSION

The GR-eHEALS is a valid instrument to assess eHealth literacy within the cohort of German athletes. Potential dangers of dealing with injury and psychological strain without reaching out for professional help should be considered.

Treatment adherence and adverse event management in chronic lymphocytic leukemia: challenges and strategies for the future

INTRODUCTION

There has been a paradigm shift in the treatment of chronic lymphocytic leukemia (CLL) over the past decade. With the advent of self-administered targeted oral anticancer agents (OAAs), the treatment of CLL has begun to shift from the infusion clinic to the patient's home. This introduced new challenges including patient non-adherence, class-specific adverse effects, and financial toxicity to treatment. In this paper, we discuss a structured approach to identifying and addressing barriers to optimal patient outcomes.

AREAS COVERED

We will ground our discussion using the five dimensions of adherence as defined by the World Health Organization (WHO): therapy factors, health-system factors, condition-related factors, social/economic factors, and patient factors. We discuss how each of these domains present in patients with CLL. We will also discuss how we can prevent and address these barriers in through the various phases of treatment.

EXPERT OPINION

A multidisciplinary program to support patients on OAAs is critical for patients with CLL. This team should involve pharmacists and social workers in addition to nursing, advanced practitioner and physician colleagues. The program should aim to identify, prevent, and address patient-specific barriers by offering individualized solutions. We describe how such a program can be designed and implemented.

Eliciting the views of left breast cancer patients' receiving deep inspiration breath hold radiation therapy to inform the design of multimedia education and improve patient-centred care for prospective patients

INTRODUCTION

The currently accepted best practice radiation treatment for left breast cancer patients is Deep Inspiration Breath Hold (DIBH) where patients hold a deep breath to reduce late cardiac and pulmonary effects from treatment. DIBH can be challenging and induce or exacerbate anxiety in patients due to the perceived pressure to reduce radiation treatment side effects. This study explored the experiences of patients treated with Deep Inspiration Breath Hold Radiation Therapy (DIBH-RT) to improve patient-centred care and inform the design of multimedia educational tools for future patients undergoing DIBH.

METHODS

This descriptive qualitative study was underpinned by a social constructivist approach to create new educational and patient care approaches based on previous patients' experiences. Semi-structured interviews were conducted with patients who had completed DIBH-RT for breast cancer. Data was analysed with reflexive thematical analysis.

RESULTS

Twenty-two patients were interviewed with five key themes identified: (1) informational needs, (2) care needs, (3) autonomy, (4) DIBH performance influencers and (5) other centredness. Recommendations were derived from these themes to improve future treatments of DIBH patients. These recommendations revolved around improvements to education, patient-centred care and strategies to improve self-efficacy with breath holding.

CONCLUSION

Patients offer a wealth of knowledge regarding their lived experiences with treatment which can enhance future patients' experiences if incorporated into their education and care. Eliciting patients' views of their DIBH-RT treatment highlighted the need to improve patient self-efficacy with DIBH through familiarity with their planned treatment from new multimedia education, and foster patient care to enhance their experience.

Relationship between fear of progression and quality of life in inflammatory bowel disease: Mediating role of health literacy and self-care

AIMS

The increasing prevalence of inflammatory bowel disease is emerging as a significant global healthcare concern due to its recurrent episodes of intestinal inflammation. This study aims to explore the relationship between fear of progression and health-related quality of life in inflammatory bowel disease patients, investigating the sequential mediating roles of health literacy and self-care.

DESIGN

A cross-sectional study.

METHODS

Eligible participants diagnosed with inflammatory bowel disease were recruited through convenience sampling method at a tertiary hospital in Shenyang, China, between May 2022 and May 2023. A total of 241 participants completed the questionnaires regarding fear of progression, health literacy, self-care and quality of life. Data analysis was conducted using SPSS 25.0 and PROCESS plug-ins.

RESULTS

(1) Fear of progression was found to be negatively associated with quality of life and had a directly predictive effect on quality of life. (2) Health literacy and self-care could independently mediate the relationship between fear of progression and quality of life. (3) There was a significant chain mediating effect of health literacy and self-care in the relationship between fear of progression and quality of life.

CONCLUSION

Fear of progression could not only directly predict the quality of life in inflammatory bowel disease patients but also indirectly affect their quality of life through the chain mediation of health literacy and self-care.

IMPACT

This study highlights the importance of nursing staff focusing on the interplay between fear of progression, health literacy, self-care and quality of life in caring for inflammatory bowel disease patients. Understanding the potential correlation mechanism underlying quality of life may help develop targeted care interventions to synergistically enhance health literacy and self-care in these patients.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No public or patient contribution.

Skin cancer screening: the experience in South Portugal

BACKGROUND

The number of skin cancer cases and related deaths continues to increase worldwide, including in Portugal. The lack of efficient health care leaves the southern Portuguese population at risk of presenting skin lesions at later stages. An initiative for skin cancer screening and medical care follow-up was created by the nonprofit organization Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul (LPCC-NRS).

METHODS

Information was gathered from 4,398 participants in several Southern Portugal regions, from January 2021 to July 2022. Descriptive and lesion risk statistical analyses were applied.

RESULTS

Participants' characteristics were described, and risk assessment was performed differentially between premalignant (n = 577) and malignant lesions (n = 176). The main risk factor for both was male gender. From the described suspicious malignant lesions, 31.8% were confirmed (n = 56), among which there were 43 basal cell carcinomas (BCC), 9 cutaneous melanomas (CM), and 4 squamous cell carcinomas (SCC).

CONCLUSIONS

Data analysis pointed to a need for improved participant recruitment, especially of male participants, and health literacy assessment in future screenings.

Association between cancer health literacy and cancer-related behavior of residents in Shandong, China

Health literacy is closely related to the incidence of major chronic diseases and its related behaviors such as cancer-related behaviors. This study explored how the cancer health literacy level affects cancer-related behaviors. About one to two villages from six cities of Shandong province were selected as sample areas. Professionals conducted face-to-face interviews with the participants. Finally, 1200 residents completed 1085 effective questionnaires. Data were analysed from a cross-sectional survey in 2019, which included 1085 residents in six cities/counties of Shandong province, China. The result showed that residents with high cancer health literacy were more likely to eat fruits and vegetables frequently, avoid eating moldy food and take exercise. Besides, they were more likely to engage in health education and have a higher willingness to pay for cancer screenings. Most residents in Shandong province have a basic level of cancer health literacy. Improving the cancer health literacy of the population can be an effective strategy to promote a healthier lifestyle, thereby reducing the incidence rates related to cancers.

Cancer Health Literacy and Its Correlated Factors in the United Arab Emirates-A Cross Sectional Study

INTRODUCTION

Cancer Health literacy (CHL) is the health literacy related to cancer knowledge, prevention, treatment, screening, and access to services. It is an important indicator of people's adherence to screening and preventive measures, which helps to reduce the incidence and prevalence of cancer. The study assessed the CHL level and its association with relevant socio-demographic characteristics and sources of information among primary health care patients and visitors in the United Arab Emirates (UAE).

METHODS

A cross-sectional study recruited survey participants who consented to respond to an interviewer-administered questionnaire. The assessment of CHL was done by using 15 questions. CHL level was measured as a median score and also categorized as poor/inadequate, moderate, good/excellent. Nominal logistic regression was used to analyze the relationship between CHL categories and participants' sociodemographic characteristics and CHL sources of information.

RESULTS

Of the total 492 participants, 45.5% were young adults (30-39 years old), 32.9% were males, and 70.8% were UAE nationals. The overall median CHL score was 8.0 (IQR = 5.0-10). 33.7% of the participants had a poor/inadequate level of CHL, 49.6% had a moderate level and 16.7% had a good to excellent level of CHL. 76.9% of the participants knew the importance of early cancer screening tests, 72.7% acknowledged the metastatic capacity of cancer, and the protective factors of cancer, especially, in colon cancer (71.7%). A high proportion of participants received health information about cancer via the internet (50.7%), television (45.3%), social media (40.2%), and doctors (43.6%). Nationality other than UAE (aOR = 1.62, 95% CI = 1.03-2.56, P = .038), having university education (aOR = 2.20, 95% CI = 1.21-3.99, P = .010) compared to those with lower than high school, and having a family history of cancer (aOR = 2.42, 95% CI = 1.33-4.41, P = .004) were positively associated with CHL. Older age (aOR = .36, 95% CI = .17-.75, P = .007 for 50-59 years, and aOR = .29, 95% CI = .11-.82, P = .019) for 60-69 years, higher-income (aOR = .57, 95% CI = .33-.99, P = .047 for 10,000-19,999 AED; aOR = .53, 95% CI = .33-.88, P = .013 for ≥20,000) compared with those earning <10,000 AED were negatively associated with CHL.

CONCLUSIONS

CHL among the resident UAE population was moderately adequate, therefore implementation of awareness campaigns seems to be warranted. Moreover, evaluation research targeting the CHL impact on cancer prevention practices and screening is also advocated.

Sociodemographic Correlates of Low Health Literacy Skills Among Cancer Survivors: National Findings From BRFSS 2016

PURPOSE

This study aimed to explore associations of sociodemographic factors with difficulties in three health literacy (HL) skills and the severity of low HL skills.

DESIGN

Cross-sectional secondary data analysis. Subjects: Data came from 17,834 adults who responded to the HL module with a response rate of 47% in the 2016 Behavioral Risk Factor Surveillance System.

MEASURES

Independent variables included sex, age, race/ethnicity, education, employment and income. Dependent variables are three HL skills: obtaining, understanding oral, and understanding written health information.

ANALYSIS

We conducted weighted Chi-square tests and multinominal logistic regressions.

RESULTS

Cancer survivors younger than 65 (aged 18-39: AOR = 4.46, P < .001; aged 40-64: AOR = 2.29, P < .001), Hispanic (AOR = 2.17, CI = 1.61-2.50, P < .01) had higher odds of difficulty obtaining health information. Female cancer survivors had lower odds of difficulty comprehending oral (AOR = .69, CI = .55-.87, P < .01) and written (AOR = .58, CI = .46-.74, P < .001) information. The relative risk ratio of having difficulties in three HL tasks was higher for those who were younger than 65 (aged 18-39: RRR = 10.18, CI = 2.41-4.3, P < .01; aged 40-64: RRR = 4.01, CI = 2.09-7.69, P < .001), Hispanic (RRR = 3.24, CI = 1.66-11.34, P < .01), unemployed (RRR = 6.1, CI = 2.88-12.76, P < .001), education levels lower than some college (some high school: RRR = 4.34, P < .01; high school: RRR = 2.62, P < .05) and household income under $25,000 (RRR = 6.99, CI = 2.8-17.5, P < .001).

CONCLUSION

Intervention and communication materials need to be tailored for patients with different HL skills considering age, gender, socioeconomic status and cultural backgrounds.

Health literacy is associated with less depression symptoms, higher perceived recovery, higher perceived participation, and walking ability one year after stroke - a cross-sectional study

INTRODUCTION

Life after stroke may entail several lifestyle changes and new routines. Hence, it is imperative for people with stroke to understand and make use of health information, i.e. to have sufficient health literacy. This study aimed to explore health literacy and its associations with outcomes at 12-months post-discharge regarding depression symptoms, walking ability, perceived stroke recovery, and perceived participation in people with stroke.

METHODS

This was a cross-sectional study of a Swedish cohort. Data were collected at 12 months post-discharge using European Health Literacy Survey Questionnaire, the Hospital Anxiety and Depression Scale, the 10-m walk test, and the Stroke Impact Scale 3.0. Each outcome was then dichotomized into favorable versus unfavorable outcome. Logistic regression was performed to assess the association between health literacy and favorable outcomes.

RESULTS

The participants, n = 108, were on average 72 years old, 60% had mild disability, 48% had a university/college degree, and 64% were men. At 12 months post-discharge, 9% of the participants had inadequate health literacy, 29% problematic health literacy, and 62% sufficient health literacy. Higher levels of health literacy were significantly associated with favorable outcomes relating to depression symptoms, walking ability, perceived stroke recovery, and perceived participation in models adjusted for age, sex, and education level.

CONCLUSION

The association between health literacy and mental, physical, and social functioning 12-months post-discharge suggests that health literacy is an important factor to consider in post-stroke rehabilitation. Longitudinal studies of health literacy in people with stroke are warranted to explore the underlying reasons for these associations.

Health literacy in older patients with abdominal tumours and its association with clinical characteristics: A cross-sectional study

PURPOSE

Health literacy (HL) is pivotal in managing patients with abdominal cancer and is associated with treatment outcomes and care experience. However, detailed characteristics of HL and their associations with clinical features remain uncertain in the population. Therefore, we aimed to comprehensively investigate HL and its associations with clinical characteristics in older patients with abdominal tumours.

METHODS

We analysed 103 older patients with abdominal tumours prescribed perioperative rehabilitation programs in an acute care hospital. The Japanese version of the European Health Literacy Survey Questionnaire was used to measure comprehensive HL. Multivariate ordinal or linear regression analyses were used to explore the associations between HL and the following clinical characteristics: physical status, physical function, cardiopulmonary function, levels of activities of daily living (ADL), physical activity level, and health-related quality of life (HR-QoL). All regression analyses included patient demographics as covariates.

RESULTS

Approximately 50%-70% of the participants had difficulty accessing and appraising health-related information, and 20%-45% thought it was difficult to understand and apply the information. The percentage of limited HL levels in general HL, three health-relevant domains, and four competencies ranged from 62% to 83%. Moreover, regression analyses revealed that lower HL was associated with worse physical status/function, lower ADL, and poorer HR-QoL.

CONCLUSION

Most older patients with abdominal tumours have limited HL, which may lead them to make treatment decisions without fully understanding what healthcare providers advise. Furthermore, patients with lower HL are at a higher risk of poor treatment outcomes because of their worse clinical characteristics.

National and subnational incidence, mortality and associated factors of colorectal cancer in China: A systematic analysis and modelling study

Background

Due to their known variation by geography and economic development, we aimed to evaluate the incidence and mortality of colorectal cancer (CRC) in China over the past decades and identify factors associated with CRC among the Chinese population to provide targeted information on disease prevention.

Methods

We conducted a systemic review and meta-analysis of epidemiolocal studies on the incidence, mortality, and associated factors of CRC among the Chinese population, extracting and synthesising data from eligible studies retrieved from seven global and Chinese databases. We pooled age-standardised incidence rates (ASIRs) and mortality rates (ASMRs) for each province, subregion, and the whole of China, and applied a joinpoint regression model and annual per cent changes (APCs) to estimate the trends of CRC incidence and mortality. We conducted random-effects meta-analyses to assess the effect estimates of identified associated risk factors.

Results

We included 493 articles; 271 provided data on CRC incidence or mortality, and 222 on associated risk factors. Overall, the ASIR of CRC in China increased from 2.75 to 19.39 (per 100 000 person-years) between 1972 and 2019 with a slowed-down growth rate (APC1 = 5.75, APC2 = 0.42), while the ASMR of CRC decreased from 12.00 to 7.95 (per 100 000 person-years) between 1974 and 2020 with a slight downward trend (APC = -0.89). We analysed 62 risk factors with synthesized data; 16 belonging to the categories of anthropometrics factors, lifestyle factors, dietary factors, personal histories and mental health conditions were graded to be associated with CRC risk among the Chinese population in the meta-analysis limited to the high-quality studies.

Conclusions

We found substantial variation of CRC burden across regions and provinces of China and identified several associated risk factors for CRC, which could help to guide the formulation of targeted disease prevention and control strategies.

Registration

PROSPERO: CRD42022346558.

Influencing factors of self-management behavior in cancer patients based on a theoretical domain framework

OBJECTIVES

To explore the factors that influence self-management behavior in cancer patients based on the theoretical domain framework.

METHODS

Studies in Chinese and English about factors influencing self-management behavior in cancer patients were searched from Wanfang database, CNKI, VIP, SinoMed, PubMed, Embase, CINAHL, Web of Science Core Collection, Cochrane library and Medline from inception to June 2022. Two investigators independently identified, extracted data, and collected characteristics and methodology of the studies. Factors were analyzed with Nvivo12, and the theoretical domain framework was mapped to the theoretical domain. Then the secondary node was generalized by theme analysis. Finally, the specific influencing factors were summarized and analyzed.

RESULTS

Thirty-four studies were included for analysis. A total of 194 factors were mapped to 13 theoretical domains, and 31 secondary nodes were summarized. Theoretical domains environmental context and resources, social/professional role and identity, and beliefs about consequences were the most common factors. Knowledge, age, self-efficacy, disease stage, social support, gender, economic status and physical status were the most influential factors for self-management in cancer patients.

CONCLUSIONS

The influencing factors of self-management of cancer patients involve most of the theoretical domains, are intersectional, multi-source and complex.

Factors associated with lymphedema self-management behaviours among breast cancer survivors: A cross-sectional study

AIMS AND OBJECTIVES

The purpose of this empirical study was to explore the current status and associated factors of lymphedema self-management behaviours among Chinese breast cancer survivors.

BACKGROUND

Breast cancer-related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self-management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self-management behaviours can help to develop targeted intervention programs.

DESIGN

A multicentre cross-sectional study.

METHODS

From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self-reported questionnaires were used to measure socio-demographic characteristics, disease-and treatment-related characteristics, lymphedema self-management behaviours, lymphedema knowledge, illness perception, self-efficacy, self-regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist.

RESULTS

Breast cancer survivors reported moderate level of lymphedema self-management behaviours. Promotion of lymph reflux management was ranked the least performed self-management behaviours, while the affected limb protection management ranked the most. 36.2% of self-management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self-efficacy, emotional illness representation and social support.

CONCLUSIONS

Lymphedema self-management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self-management varied with different socio-demographic characteristics, along with different levels of knowledge, self-efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self-management behaviours.

RELEVANCE TO CLINICAL PRACTICE

This study addressed that breast cancer survivors' lymphedema self-management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self-management performance and adherence.

Attitudes toward cancer screening in regional Japan during the COVID-19 pandemic: An anonymous survey

The coronavirus disease (COVID-19) pandemic has raised concerns about the impact of delayed health check-ups and cancer screenings on cancer diagnosis and treatment. This study aimed to investigate the awareness of cancer patients on future screening measures during the pandemic in rural Japan. An anonymized open-data survey was undertaken in Fukui Prefecture, a rural region of Japan, in 2021. Participants were asked about their cancer screening history, screening frequency during the pandemic, and reasons for not undergoing screening. Among the 1262 respondents, the proportion of patients who underwent cancer screening in 2020 during the pandemic was similar to the proportion who underwent regular (annual or biannual) screening in 2019 before the pandemic. Of those who underwent regular screening, 82% still underwent screening in 2020, while only 21% of those who had irregular screenings. The number of respondents who believed they were healthy and did not require screening increased over time, possibly due to restrictions on going out and refraining from activities during the pandemic. This study in rural Japan found that regular cancer screening prior to the pandemic was associated with a more positive attitude toward screening during the pandemic. Raising awareness about the importance of cancer screening and encouraging participation is crucial for promoting positive attitudes in the future. The findings highlight the need for continued efforts to ensure access to screening services during the pandemic and future public health emergencies.

Cancer Screening and Treatment Delays During the COVID-19 Pandemic and the Role of Health Literacy in Care Re-engagement: Findings from an NCI-Designated Comprehensive Cancer Center sample

The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. A total of 1,533 participants completed the survey, and nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cancer screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.

Health literacy on quality of life for children with cancer: modules on pediatric palliative care

Objective

To describe the development of educational materials for parents and other caregivers of children with cancer, which utilized a culturally sensitive approach to reduce acceptance barriers to palliative care (PC).

Methods

The Pan American Health Organization (PAHO), St. Jude Children's Research Hospital, and partners in Latin America and the Caribbean collaborated in a three-phase project, beginning with a needs assessment survey of caregivers of children with cancer in Peru. Based on this finding, an interdisciplinary team of pediatric PC experts developed educational content that was designed and validated by an international committee of PC and communication experts.

Results

The collaboration resulted in the development of an eight-module series that introduces caregivers to key concepts of pediatric PC, including management of pain, quality of life, and end of life care. The series was designed to reduce caregiver stigma associated with PC through culturally sensitive education that addresses the low levels of health literacy among caregivers in Latin America and the Caribbean. In the 15 months since the launch, these modules have been distributed throughout Latin America and were downloaded 2 825 times.

Conclusions

Educational materials and anticipatory guidance of PC were considered to be a priority for parents and other caregivers of children with cancer throughout Latin America. The materials developed through this project have been widely utilized and are available through the PAHO website and the Together by St. Jude™ online resource.

Self-Care Behaviour of Patients With Breast Cancer in the Management of Side Effects of Chemotherapy

Aim The breast is the leading site of cancer among females. Chemotherapy is the standard treatment of breast cancer and it results in multiple side effects. Apart from pharmacological management, self-care behaviors may significantly influence the management of these side effects. The study aimed to assess the self-care behavior of patients with breast cancer in the management of side effects of chemotherapy. Methods A longitudinal descriptive study was conducted at the Daycare chemotherapy unit of the Radio Therapy Department, Government Medical College Hospital Thiruvananthapuram, Kerala, India. In total, 170 female patients with breast cancer receiving their first cycle of chemotherapy participated in the study. Self-care behavior was the primary outcome variable of the study. Sociodemographic and clinical data were measured by using a structured questionnaire. The severity of side effects and self-care behaviors for their management were measured by a Self Care Diary (SCD). Result A total of 170 with breast cancer receiving chemotherapy participated in the study. The severity of side effects and self-care behaviors for their management were measured at two separate time intervals, T1 and T2. Severe fatigue was found in 80.0% of participants at T1 and 61.2% at T2. Vomiting (47.7%), mucositis (48.2%), and nausea (49.1%) were also found to be severe at T1, but these side effects were moderate (53.8%, 58.8%, and 51.8% respectively) at T2. Despite the high number of self-care behaviors used to prevent infection, nausea/vomiting, bleeding, decreased appetite, sleeping difficulty, and constipation, overall self-care behaviors were found to be poor. A negative correlation was found between self-care behavior and side effects of chemotherapy. Conclusion The study revealed a negative correlation between self-care behaviors and side effects. This indicates that supportive education and training should be given to patients and caregivers to enhance the self-care behaviors of patients to manage the side effects.

Caregiver and care recipient health literacy, social support and connectedness on caregiver psychological morbidity: A cross-sectional dyad survey

BACKGROUND

Caregivers play an important role supporting people diagnosed with cancer, yet report significant unmet information and support needs that impact on their psychological wellbeing. Health literacy and social connectedness are key factors that influence wellbeing, yet few studies have examined their relative role in psychological wellbeing of carers. This study investigated relationships between caregiver and care recipient health literacy, social support, and social connectedness on psychological morbidity in a cancer setting.

METHODS

This cross-sectional study included 125 caregiver-cancer care recipient dyads. Participants completed the Health Literacy Survey-EU-Q16, Social Connectedness Scale-Revised, the Medical Outcomes Study-Social Support Survey, and the Depression, Anxiety and Stress Scale-21 (DASS21). Relationships between factors were examined using hierarchical multiple regression with care recipient factors entered at Step 1 and caregiver factors at Step 2.

RESULTS

Most caregivers provided care for their spouse (69.6%); caregivers mean total DASS21 score was 24.38 (SD = 22.48). Mean DASS21 subscale scores for depression, anxiety, stress in caregivers were 4.02 (SD = 4.07), 2.7 (SD = 3.64), and 5.48 (SD = 4.24) respectively, suggesting normal range of depression and stress, and mild anxiety. Care recipients had a diagnosis of breast (46.4%), gastrointestinal (32.8%), lung (13.6%), or genitourinary (7.2%) cancer, and a mean DASS21 score of 31.95 (SD = 20.99). Mean DASS21 subscale scores for depression, anxiety, stress in care recipients were 5.10 (SD = 4.18), 4.26 (SD = 3.65), and 6.62 (SD = 3.99) respectively, suggesting mild depression and anxiety, and normal stress scores. Regression analyses showed that only caregiver factors (age, illness/disability, health literacy and social connectedness) were independent predictors of caregiver psychological morbidity (F [10,114] = 18.07, p < 0.001).

CONCLUSION(S)

Only caregiver, and not care recipient, factors were found to influence caregiver psychological morbidity. While both health literacy and social connectedness influenced caregiver psychological morbidity, perceived social connectedness had the strongest influence. Interventions that ensure caregivers have adequate health literacy skills, as well as understand the value of social connection when providing care, and are supported to develop skills to seek support, have the potential to promote optimal psychological wellbeing in cancer caregivers.

Factors related with nursing students' health literacy: a cross sectional study

Background

Nursing professionals have a crucial role in promoting health literacy in health services, so it is necessary to ensure health literacy skills in future health professionals.

Objective

The objective of the study was to examine the health literacy of nursing students and its associated factors.

Methods

A cross-sectional descriptive study was carried out on 460 nursing students. For data collection, a semi-structured questionnaire was obtained on sociodemographic characteristics, perception and health care, use of the health system and lifestyles. In addition, health literacy was assessed using the European Health Literacy Questionnaire.

Results

6.1% of the participants had an inadequate level of health literacy and 36.5% problematic. The probability of having sufficient health literacy is directly associated with age; and inversely with smoking, prolonged screen time and living alone (p < 0.05).

Conclusion

A large percentage of nursing students need to improve their health literacy skills. It is necessary to integrate a greater number of contents in health literacy in the curriculum of nursing students.

Interactive Health Literacy and Symptom Self-management in Patients With Lung Cancer: A Critical Realist Analysis

BACKGROUND

Patients with lung cancer experience multiple symptoms requiring self-management. Little is known about how self-management is influenced by interactive health literacy, defined as communicating with healthcare providers to obtain and process information.

OBJECTIVE

This study explored how interactive health literacy relates to symptom self-management among patients with lung cancer. A second aim explored how interactive health literacy might be integrated into the Individual and Family Self-management Theory.

METHODS

This study used a cross-sectional mixed-methods design. Quantitative data included demographics, the All Aspects of Health Literacy Scale, and the Memorial Symptom Assessment-Short Form. Qualitative data were collected using semistructured interviews. Data analysis followed a critical realist model.

RESULTS

Twelve adults who recently received treatment for lung cancer reported an average of 14 symptoms that caused moderate distress. Average interactive health literacy of the sample was in the moderate range. Participants' experiences of self-management differed based on their interactive health literacy. A generative mechanism proposes that those with higher interactive health literacy who accessed online information used this information as a basis for engaging with providers regarding potential symptom self-management strategies.

CONCLUSIONS

Interactive health literacy skills may play a role in patients' ability and confidence in symptom self-management through interactions with oncology providers. Further research should clarify the relationship between interactive health literacy, self-efficacy, and collaboration with oncology providers.

IMPLICATIONS FOR PRACTICE

The patient-provider relationship is a key factor influencing how patients obtain and process symptom self-management information. Oncology providers should implement patient-centered strategies to engage patients in symptom self-management.

Integrating Palliative Care Into Self-management of Breast Cancer: A Pilot Randomized Controlled Trial

BACKGROUND

Breast cancer patients may not be well-informed about palliative care, hindering its integration into cancer self-management.

OBJECTIVE

The aim of this study was to test Managing Cancer Care: A Personal Guide (MCC-PT), an intervention to improve palliative care literacy and cancer self-management.

METHODS

This was a single-blind pilot randomized controlled trial to evaluate the feasibility/acceptability and intervention effects of MCC-PT on palliative care literacy, self-management behaviors/emotions, and moderation by demographic/clinical characteristics. We enrolled 71 stages I to IV breast cancer patients aged at least 21 years, with >6-month prognosis at an academic cancer center. Patients were randomized to MCC-PT (n = 32) versus symptom management education as attention-control (n = 39). At baseline, 1 month, and 3 months, participants completed the Knowledge of Care Options Test (primary outcome), Control Preferences Scale, Goals of Care Form, Medical Communication Competence Scale, Measurement of Transitions in Cancer Scale, Chronic Disease Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Mishel Uncertainty in Illness Scale.

RESULTS

Mean participant age was 51.5 years (range, 28-74 years); 53.5% were racial/ethnic minority patients, and 40.8% had stage III/IV cancer. After adjusting for race/ethnicity, MCC-PT users improved their palliative care literacy with a large effect size (partial η2 = 0.13). Patients at late stage of disease showed increased self-management (partial η2 = 0.05) and reduced anxiety (partial η2 = 0.05) and depression (partial η2 = 0.07) with medium effect sizes.

CONCLUSIONS

Managing Cancer Care: A Personal Guide is feasible and appears most effective in late-stage cancer. Research is needed to elucidate relationships among cancer stage, race/ethnicity, and self-management outcomes.

IMPLICATIONS FOR PRACTICE

Integration of palliative care into cancer care can assist in creation of appropriate self-management plans and improve emotional outcomes.

Adherence to swallowing recommendations during (chemo)radiotherapy in head and neck cancer survivors: a scoping review

PURPOSE OF REVIEW

There is a paucity of knowledge regarding patient adherence to dysphagia recommendations. It is recognized that unique barriers and facilitators contribute to poor treatment adherence in head and neck cancer (HNC) survivors. This review aims to identify the key themes and knowledge gaps regarding adherence to swallowing recommendations in HNC survivors during (chemo)radiotherapy (C)RT.

RECENT FINDINGS

Seven studies were identified. Six facilitators to adherence were extracted, namely pain relief, behavioural intervention, attendance at multidisciplinary clinic, individualised swallowing therapy, absence of prophylactic percutaneous endoscopic gastronomy (PEG) and positive social control from a spouse. Barriers to adherence included pain, depression and presence of prophylactic PEG. Adherence to swallowing recommendations positively impacted swallowing outcomes in one study.

SUMMARY

Little is known about adherence to swallowing recommendations during (C)RT in HNC survivors. Capturing adherence is challenging. Several knowledge gaps were identified. Further research is needed to better understand the barriers and facilitators from the survivors' perspective. This will inform development of best practice regarding how swallowing recommendations are provided to promote adherence and improve outcomes.

Patients' perceived challenges, competencies, and supportive care needs during acute clinical treatment of breast or gynecological cancer

OBJECTIVE

This study aimed to examine challenges, competencies, and supportive care needs (SCN) of women with breast or gynecological cancer during acute cancer treatment and associations to other health-related variables.

METHODS

We surveyed 120 patients with breast or gynecological cancer at the end of acute cancer treatment, either directly after surgery or during adjuvant chemotherapy. We assessed challenges, subjective competencies, and SCN using a self-developed measure comprising 25 items referring to coping tasks assigned to six domains. In addition, patients' competencies and health literacy (HL) were assessed.

RESULTS

Most patients felt at least moderately challenged by coping tasks concerning psychological distress (e.g., dealing with fears and insecurities, 70.2%; coping with cancer diagnosis, 69.6%) and physical complaints (e.g., dealing with a reduced physical capacity, 56.6%). About 42.5%-71.4% of patients who evaluated coping tasks as highly challenging felt competent to deal with these challenges themselves. Less than half of patients reported SCN, mainly regarding psychological concerns. The extent of challenging coping tasks, patients' perceived ability to overcome challenges themselves, and SCN showed associations to patient competencies and HL.

CONCLUSIONS

SCN regarding psychological concerns and health behavior should be addressed in acute cancer care and rehabilitation programs. In addition, promoting HL might be essential in strengthening patients' subjective competencies related to various coping tasks.

Brain Tumor at Diagnosis: From Cognition and Behavior to Quality of Life

BACKGROUND

The present narrative review aims to discuss cognitive-emotional-behavioral symptoms in adults with brain tumors at the time of diagnosis.

METHODS

The PubMed database was searched considering glioma, pituitary adenoma, and meningioma in adulthood as pathologies, together with cognitive, neuropsychological, or behavioral aspects.

RESULTS

Although a significant number of studies describe cognitive impairment after surgery or treatment in adults with brain tumors, only few focus on cognitive-emotional-behavioral symptoms at diagnosis. Furthermore, the importance of an effective communication and its impact on patients' quality of life and compliance with treatment are seldom discussed.

CONCLUSIONS

Adults with brain tumors have needs in terms of cognitive-emotional-behavioral features that are detectable at the time of diagnosis; more research is needed to identify effective communication protocols in order to allow a higher perceived quality of life in these patients.

Improving Breast Cancer Family Caregivers' Palliative Care Literacy: A Pilot Randomized Trial

Self- and family management (SFM) refers to patients' and family caregivers' activities to co-manage illness. Two barriers to SFM are low palliative care literacy and lack of goals of care communication, which potentially result in SFM activities that are unsupportive of patients' goals. Managing Cancer Care: A Caregiver's Guide (MCC-CG) aims to improve palliative care literacy and communication within a SFM training program. In this pilot randomized trial, we enrolled breast cancer family caregivers and collected data at 0, 1, and 3 months on palliative care literacy, SFM engagement, communication, transitions management, uncertainty, caregiver burden, and caregiver competence/personal gain. Participants (n = 35) had a mean age of 54 (range: 18-81) and were 66% white and 34% racial/ethnic minorities. Intervention participants improved their palliative care literacy and SFM engagement, reduced uncertainty and caregiver burden, increased competence/personal gain, and had more goals of care conversations over time. MCC-CG has preliminary efficacy, warranting further study.

Self-efficacy to Get Cancer-Related Information or Advice

Self-efficacy, or confidence, for being able to get cancer information may affect a person's understanding of cancer risk and subsequent cancer-related decisions such as screening, treatment, and genetic testing. In this study, we explored key correlates associated with self-efficacy for getting cancer information. We analyzed cross-sectional data from the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2). There were 3504 responses in the full dataset; 2513 remained after eliminating respondents with incomplete data for all variables of interest. Self-efficacy for getting cancer information was assessed with the item, "Overall, how confident are you that you could get advice or information about cancer if you needed it?" First, we explored correlates associated with self-efficacy in getting cancer information including sociodemographic factors, patient-provider communication, and health-related self-efficacy in the full sample. Secondarily, we examined associations between self-efficacy to get cancer information and cancer information-seeking burden (e.g., difficulty understanding cancer information) in the subset of participants who reported ever looking for cancer-specific information. Descriptive statistics and logistic regressions were conducted. Asian race/ethnicity, higher perceived quality of patient-provider communication, and higher health-related self-efficacy were associated with higher odds of confidence about getting cancer information. In the subset of people who ever sought cancer-specific information, higher patient-provider communication scores, higher health-related self-efficacy, greater difficulty understanding information, greater concern about the quality of information, and greater frustration during the search were associated with higher self-efficacy for getting cancer information. Future research should evaluate strategies to improve cancer information seeking skills.

Do members of cancer peer support groups know more about cancer than non-members? Results from a cross-sectional study in Germany

PURPOSE

This study aims to assess whether cancer-specific knowledge (CSK) is associated with membership in a cancer peer support group (PSG) and other factors.

METHODS

A cross-sectional study investigated the CSK of 1121 cancer patients of various entities across Germany. CSK was measured with the BCKS-14, a 14-item knowledge instrument which was previously participatory developed with patient representatives and oncologists. Associations between CSK and PSG membership, sociodemographic factors, internet use, and preferences in medical decision-making were analysed with t-tests and multiple linear regressions.

RESULTS

The t-test showed a statistically significant difference in CSK between members and non-members of PSGs. Knowledge for PSG members was on average 0.97 points higher (p < 0.001) and varied between 2 and 14 points compared to 0-14 points for non-members. Regression analysis revealed age, gender, time since diagnosis, education, internet use, and PSG activity to be statistically significant predictors. Younger (β =  - 0.15; p < 0.001), female (β = 0.10; p = 0.001), higher educated patients (β = 0.27; p < 0.001) with and a diagnosis longer ago (β = 0.10; p = 0.002) who use the internet frequently for information seeking (β = 0.20; p ≤ 0.001) and members of cancer PSGs (β = 0.18; p ≤ 0.001) showed a higher CSK.

CONCLUSION

Overall, CSK of the participants shows a high degree of variance. CSK should be promoted for all patients and especially for older, newly diagnosed patients with low educational levels and PSGs introduced early on as they contribute to improving CSK among other benefits.

Psychometric properties of the German revised version of the eHealth literacy scale in individuals with cardiac diseases: Validation and test of measurement invariance

Background

The internet is most people's primary source of (health) information. However, no validated instrument exists to assess eHealth literacy in the group of patient with cardiac diseases.

Objective

The objective of this study was the evaluation of the psychometric properties of the German revised version of the eHealth literacy scale (GR-eHEALS) in individuals with coronary artery disease (CAD) and congestive heart failure (CHF).

Methods

A cross-sectional study was conducted. N = 455 were included in the statistical analyses. The assessment compromised the GR-eHEALS, medical history, sociodemographic data, and technology-related data. Confirmatory factor analyses, correlational analyses, and tests of measurement invariance were performed.

Results

The two-factorial model reached a good model fit. The sub-scales information seeking and information appraisal, as well as the eHealth literacy total score, reached high reliability coefficients. Construct and criterion validity was fully confirmed For the two-factorial model, measurement invariance up to the scalar level could be confirmed regarding the sociodemographic characteristics sex, age, and educational level.

Conclusions

This study confirmed the two-factor structure, construct, and criterion validity as well as measurement invariance at the scalar level for sex, age, and educational level of the GR-eHEALS scale in a sample of individuals with CAD and CHF.

Relationship between knee joint discomfort, self-management behavior, and quality of life in the middle-aged and elderly people in China: A cross-sectional study

Background

The aim of this study was to describe the knee joint discomfort, self-management behavior, and quality of life (QoL) in the middle-aged and elderly people in China and to clarify the relationship between the knee joint discomfort, self-management behavior, and QoL.

Methods

It is a cross-sectional study and in this study, a stratified multistage random sampling method was used to collect data on the three factors such as knee joint discomfort, self-management behavior, and QoL among the middle-aged and elderly people in the Hunan Province. Spearman's correlation analysis was used to test the relationship between the knee joint discomfort, self-management behavior, and QoL.

Results

The results of the present study showed that among them, the prevalence of knee pain was the highest (52.1%), followed by knee weakness (42.5%), numbness (41.8%), cold feeling (40.0%), tenderness (38.3%), and distension feeling (37.5%). Average score of self-management of knee joint discomfort in the middle-aged and elderly people was 2.14 ± 0.67. The level of self-management in each dimension ranged from high to low as emotional management, daily management, symptoms management, and information management. The average scores of physical component summary (PCS) and mental component summary (MCS) were 42.85 ± 5.34 and 43.62 ± 8.43, respectively. The occurrence, frequency, and severity of discomfort symptoms were positively correlated with the symptoms management, daily management, information management, and self-management behaviors, and negatively correlated with the emotional management, PCS and MSC, except for the occurrence of discomfort symptoms (P < 0.05).

Conclusion

Knee joint discomfort was prevalent in the middle-aged and elderly people. In addition, they displayed a low level of self-management behavior and poor QoL. The middle-aged and elderly people faced knee discomfort symptoms, the more frequent and severe symptoms, the higher level of symptom management, daily management, and information management, and the lower level of emotional management and QoL.

A qualitative study of blood glucose and side effect self-management among patients with type 2 diabetes undergoing chemotherapy for cancer

Objective

This study aimed to identify the process by which patients with type 2 diabetes who are undergoing chemotherapy for cancer personally manage their blood glucose levels and side effects.

Methods

Semi-structured interviews were conducted with 16 patients with cancer who had completed chemotherapy while taking hypoglycemic drugs. The interview data were analyzed using the modified grounded theory approach proposed by Kinoshita.

Results

Self-management comprised balancing the management of blood glucose levels and side effects according to physical condition. After commencing chemotherapy, participants experienced confusion regarding the side effects and hyperglycemia they have not previously experienced, started struggling with side effects while paying attention to blood glucose fluctuations, experienced simplification of convalescence based on the diabetes experience, and used trial and error to cope with side effects. When participants learned to understand the changes in blood glucose fluctuations and the pattern of physical recovery, they completed chemotherapy by adjusting their physical condition to the treatment by varying self-control.

Conclusions

Healthcare providers need to assist patients receiving chemotherapy to promote self-management of both blood glucose levels and side effects of the chemotherapy, depending on their physical condition. It is essential that patients with type 2 diabetes who are undergoing chemotherapy achieve the ability to self-monitor their blood glucose levels and side effects.

Documenting limited health literacy in a clinical setting

Objective

Health literacy is important in lung cancer care, where treatments and symptoms are difficult to navigate. This study aims to describe how a single-item measure of health literacy can facilitate health literacy system capacity.

Methods

Data include retrospective medical records from 456 patients with lung cancer. Limited or adequate health literacy was based on participant response to the Single Item Literacy Screener (SILS). Data were collected over a 12-month period following diagnosis for each patient.

Results

One-third of patients had limited health literacy; they were more likely to have lung cancers of stage IIIB or higher and greater median levels of depression based on the PHQ-9 questionnaire. Patients with limited health literacy were also more likely to have at least one emergency department visit or unplanned hospitalization and had these visits sooner.

Conclusion

These data document need for interventions to buffer the association between limited health literacy and poor health outcomes.

Innovation

Routine intake screens should include the SILS to measure health literacy among lung cancer patients. New models that address health literacy at the organizational and patient levels can be implemented in health care settings using the SILS.

The central role of peers facilitators in the empowerment of breast cancer patients: a qualitative study

Background

In 2020, the number of new cancer cases was estimated at 20 490 862 worldwide up from 18.1 million in 2018 and 14.1 million in 2012. Since the 2000s, cancer treatments have significantly improved, allowing either a cure or control of the disease. Patients share their experience of the disease and use supportive care solutions through involvement in patient associations and online forums. All the associations were built on the principle of “peer support,” which is based on mutual aid between people who suffer or have suffered from the same somatic or psychological illness or had the same life experience.

This experiential knowledge can be explored to understand the role of peers and associations in the appropriation of their cancer.

Methods

A qualitative phenomenological study was undertaken through semi-structured interviews with 12 participants. Interviews were audio-recorded, transcribed verbatim, then analyzed by means of triangulation up to the point of theoretical saturation by a semio-pragmatic method.

Results

Four categories emerged: (1) “Transforms a painful experience into a positive one. It mobilizes the human values of sharing, love, and humility, which facilitates resilience”; (2) “The characteristics of the association, a non-medical place between people sharing a common destiny, resonates with patients’ needs and improves their well-being”; (3) “The association transforms the patients’ experiences by facilitating engagement that leads to a patient-expert (empowerment)”; and (4) “Understanding what is happening to them is soothing, reassuring, because patients’ concerns need to be heard and their care understood”.

Conclusions

This study highlights patient associations can serve as the mediator of NPI and facilate the empowerment of breast cancer patients.

Practice implications

Educating health professionals in initial and continuing education about non-pharmacological interventions will be a major issue. Teaching the patient-centred approach to health professionals is one of the priorities in initial and continuing medical education.

The policy environment of self-care: a case study of the Philippines

Self-care is the ability and empowerment of individuals to maintain health through informed health-care decisions, with or without the support of a health provider. High-income countries have made advances to their conceptualization, research and institutionalization of self-care, given its reported benefits to patients, the health system and economy. A similar undertaking in low- and middle-income countries (LMICs) with already fragile health systems is warranted as highlighted by the coronavirus disease 2019 pandemic. Our article therefore aimed to describe and analyse the policy environment of self-care using the Philippines as a case study, which may have relevance to other similar countries and settings that are transitioning towards Universal Health Care (UHC) to reform and strengthen their primary care systems. We conducted 13 key informant interviews and 2 focus group discussions among representatives from the government, the pharmaceutical retail/industry, community retail pharmacy, primary health physicians and health workers, an infirmary administrator and patients and/or patient advocates. We triangulated our qualitative data with findings from our policy review. We found a total of 13 relevant policies on self-care in the Philippines recently drafted and/or implemented from 2016 to 2021 that fall under the broad categories of unifying frameworks and road maps, capacity building and institutional streamlining, regulations and disease guidelines. Our case study highlights the role of the UHC Law as a driver for self-care and patient empowerment towards better health outcomes with its passage resulting in the promulgation of self-care-related policies. Our findings also suggest that changes in the local policy and built environment, and the formal educational and health systems, are needed to foster a culture of responsible self-care. There are notable exemplars in advancing self-care in the region, including Thailand, from which LMICs like the Philippines can draw lessons to make progress on institutionalizing self-care and, ultimately, realizing UHC and Health For All.

Self-efficacy in managing post-treatment care among oral and oropharyngeal cancer survivors

OBJECTIVE

Physical and psychosocial effects of oral cancer result in long-term self-management needs. Little attention has been paid to survivors' self-efficacy in managing their care. Study goals were to characterise self-care self-efficacy and evaluate socio-demographics, disease, attitudinal factors and psychological correlates of self-efficacy and engagement in head and neck self-exams.

METHODS

Two hundred thirty-two oral cancer survivors completed measures of socio-demographics, self-care self-efficacy, head and neck self-exams and attitudinal and psychological measures. Descriptive statistics characterised self-efficacy. Hierarchical regressions evaluated predictors of self-efficacy.

RESULTS

Survivors felt moderately confident in the ability to manage self-care (M = 4.04, SD = 0.75). Survivors with more comorbidities (β = -0.125), less preparedness (β = 0.241), greater information (β = -0.191), greater support needs (β = -0.224) and higher depression (β = -0.291) reported significantly lower self-efficacy. Head and neck self-exam engagement (44% past month) was relatively low. Higher preparedness (OR = 2.075) and self-exam self-efficacy (OR = 2.606) were associated with more engagement in self-exams.

CONCLUSION

Many survivors report low confidence in their ability to engage in important self-care practices. Addressing unmet information and support needs, reducing depressive symptoms and providing skill training and support may boost confidence in managing self-care and optimise regular self-exams.

A Survey of Older Adults' Self-Managing Cancer

BACKGROUND

Older adults living with cancer can experience significant challenges in managing their cancer treatment[s], care, and health. Cancer self-management is much discussed in the research literature, but less is known about the perceptions and experiences of older adults', including their self-management capacities and challenges. This study explored the factors that supported and hindered cancer self-management for older Canadian adults living with cancer.

METHODS

We conducted a 17-item population-based telephone survey in the Canadian province of British Columbia among older adults (age ≥ 65) living with cancer. Descriptive and inferential statistics were used to analyze quantitative data and thematic analysis for open-text responses.

RESULTS

129 older adults participated in the study (median age 76, range: 65-93), of which 51% were living with at least one other chronic illness. 20% reported challenges managing their cancer treatment and appointments, while only ~4% reported financial barriers to managing cancer. We organized the findings around enabling and encumbering factors to older adults cancer self-management. The main encumbering factors to self-management included health system and personal factors (physical and emotional challenges + travel). Whereas enablers included: access to interpersonal support, helpful care team, interpersonal support and individual mindset.

CONCLUSIONS

Considering factors which enable or encumber older adults' cancer self-management is critical to supporting the growing aging population in the work required to manage cancer treatment and navigate cancer services. Our findings may guide the development of tailored resources for bolstering effectual self-management for older Canadians living with cancer.

Adapting a palliative care-focused cancer self- and family management intervention for use in Israel

BACKGROUND

In Israel, there is a need to improve quality of life and health outcomes among patients and families facing cancer. Increasing awareness of, literacy about, and availability of palliative care may further this goal.

AIMS

This study aimed to adapt a palliative care-focused cancer self- and family management intervention developed in the US for use in Israel.

METHODS

The Managing Cancer Care (MCC) psycho-educational intervention is comprised of Managing Cancer Care: A Personal Guide (MCC-PT^©) for patients and Managing Cancer Care: A Caregiver's Guide (MCC-CG^©) for family caregivers. Following translation into Hebrew, an expert panel of Israeli nurses edited the MCC tool for cultural relevance. The authors then conducted qualitative interviews with patients with breast cancer and their family caregivers to obtain feedback. Data were analysed using qualitative content analysis.

FINDINGS

Following recommendations from Israeli experts in oncology and/or palliative care (n=3), the authors revised intervention content specific to the US healthcare system and culture. Patients' (n=13) and family caregivers' (n=10) reported MCC as attractive (70%, 80%), topically relevant (80%, 70%), and culturally appropriate, but felt that palliative care resources should be more Israel-specific.

CONCLUSION

The MCC tool is acceptable to potential users, warranting further pilot-testing.

Relationship between communicative and critical health literacy, health information sources, and participation in health checkups among middle-aged Japanese community residents

We assessed the relationship between health literacy and participation in health checkups among middle-aged Japanese community residents. Additionally, we explored the health information sources related to participation in health checkups among those with low, medium, and high health literacy. This mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents with National Health Insurance (NHI), aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3582 participants. Health literacy was measured by the Communicative and Critical Health Literacy (CCHL) scale, and participants were classified into three groups (low, medium, and high health literacy groups) by the tertiles of CCHL scale score. After adjusting for confounding factors, the multivariable-adjusted odds ratios for non-participation in health checkups were 1.20 (95% CI 1.01-1.43, p = 0.039) in the medium health literacy group and 1.47 (95% CI 1.20-1.80, p < 0.001) in the low health literacy group compared with the high health literacy group. Additionally, some health information sources were associated with participation in health checkups in the medium and high health literacy groups, whereas none of the health information sources were associated with participation in health checkups in the low health literacy group. We believe that it is important to develop materials and interventions aimed at low health literacy populations to promote participation in health checkups.

The importance of health literacy for self-management: A scoping review of reviews

OBJECTIVES

Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support.

METHODS

We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010.

RESULTS

A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients' perspective described mainly medical management and the communication and navigation of the health care system.

DISCUSSION

Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.

A systematic review of the association between health literacy and pain self-management

OBJECTIVE

To synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes.

METHODS

This systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies.

RESULTS

Twenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education.

CONCLUSIONS

Limited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation.

PRACTICE IMPLICATIONS

Using brief functional literacy scales in the clinical environment can be more practical. Identifying patients' literacy levels helps clinicians personalize education, which then promotes patients' knowledge of pain, medication regimen adherence, and pain control.

Nursing interventions to promote patient engagement in cancer care: A systematic review

BACKGROUND

Patient engagement is becoming increasingly relevant in cancer care. Nurses have been recognized as crucial in promoting active engagement of people with carcer. Despite the growing interest on this topic and the relevance of patient engagement interventions to improve patient' conditions, to the best of our knowledge there is no synthesis of the literature on the characteristics and impact of nurse-led patient engagement intervention for adults with cancer.

OBJECTIVE

This review aims to systematically summarize nurse-led patient engagement interventions for adult patients diagnosed with cancer and to describe the state of the art on the impact of these interventions on patients' outcomes.

DESIGN

Systematic review.

SETTING(S)

Hospital and outpatient care.

PARTICIPANTS

Adults with cancer.

METHODS

We searched PubMed, CINAHL, Embase, Scopus, Web of Science and Cochrane library from 2005 to 2021. We included randomized clinical trials, quasi-experimental studies and single-arm, pre-test/post-test studies written in English, Spanish, French and Italian. All the included articles reported nurse-led patient engagement interventions designed to improve patient engagement in the management of their own disease and to assess outcomes related to patient engagement. We appraised the methodological quality of the included articles with the Joanna Briggs Institute appraisal tools.

RESULTS

Twenty-four articles met the inclusion criteria. Four distinct types of nurse-led engagement interventions, showing different degrees of complexity, were classified: (i) generic health information delivery, (ii) patient-specific information delivery, (iii) personalized decision support and (iv) motivational support. These interventions were effective in supporting behavioral changes and reducing symptoms burden of adults with cancer. In addition, many of the retrieved studies showed significant increase in patients' knowledge, informed decisions making, perceived quality of nurse-patient interaction and quality of life after the engagement intervention.

CONCLUSIONS

This systematic review summarized a wide variety of nurse-led patient engagement interventions with different degrees of complexity. In addition, a significant positive effect of these interventions was found on outcomes such as patient activation, self-efficacy, health literacy and quality of life. Among those identified, nurse-led motivational interventions appear to be the most effective ones for improving engagement outcomes in adults with cancer.

REGISTRATION NUMBER

PROSPERO Nr: CRD42020146189.

Prostate cancer survivor capacity to engage in survivorship self-management: a comparison of perceptions between oncology specialists, primary care, and survivors

PURPOSE

The rapidly increasing number of prostate cancer survivors in tandem with a forthcoming shortage of oncology specialists in our health system poses a barrier to ensuring that high-quality survivorship care is available to support this population. As such, there is a need to consider ways to optimize survivorship care, while taking health system constraints into account. The purpose of this study is to explore the perceptions of survivorship self-management between oncology specialists, primary care providers (PCPs), and survivors themselves.

METHODS

A single cross-sectional survey, relating to how prostate cancer survivorship care could be improved, was administered to each group.

RESULTS

Two hundred forty-three participants (N = 206 survivors, N = 10 oncology specialists, N = 27 PCPs) completed the study survey. Most PCPs (90%) and oncology specialists (84%) perceived that an opportunity for prostate cancer survivors to have an expanded role in their care would be beneficial. Nearly half (49%) of survivors reported that it would be beneficial to have an expanded role in their survivorship care with only 11% indicating that it would not be beneficial at all.

CONCLUSIONS

Barriers to developing this model involve limited oncology specialist time to execute survivorship plans, limited communication between oncology specialists and PCPs, and a lack of primary care and survivor education targeted specifically to prostate cancer survivorship.

Interaction between self-perceived disease control and self-management behaviours among Chinese middle-aged and older hypertensive patients: the role of subjective life expectancy

Background

One of the effective ways to control hypertension is long-term self-management, which is difficult to maintain. Therefore, understanding how people engage in the process of self-management behaviour change is necessary. In this study, we aimed to examine the dynamic relationship between self-perceived disease control and self-management behaviours in Chinese middle-aged and older hypertensive patients, namely, medication use, self-monitoring, physical activity, tobacco and alcohol avoidance, and to explore the mediating role of subjective life expectancy (SLE) on this relationship.

Methods

Data were obtained from a nationally representative sample of 508 middle-aged and older hypertensive patients (aged 45+) from the 2013, 2015, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. A cross-lagged panel model combined with mediation analysis was used to determine the dynamic relationship between self-perceived disease control and self-management behaviours and to clarify the mediating effect of SLE on this ascertained relationship.

Results

Good self-perceived disease control subsequently predicted good medication use, self-monitoring and physical activity, and vice versa. Subjective life expectancy (SLE) partially mediated the prospective reciprocal relationships between self-perceived disease control and these self-management behaviours, which accounted for 37.11, 25.88, and 19.39% of the total effect of self-perceived disease control on medication use, self-monitoring and physical activity, respectively. These self-management behaviours had a significant and positive feedback effect on self-perceived disease control. However, neither the direct and indirect effects (via SLE) of self-perceived disease control on tobacco and alcohol avoidance were revealed.

Conclusions

Positive feedback loops of present self-perceived disease control, future SLE and self-management behaviours (medication use, self-monitoring, and physical activity) help middle-aged and older hypertensive patients adhere to these behaviours but are useless for the avoidance of addictive behaviours. Interventions aimed at enhancing the effect perception of general self-management behaviours (e.g., medication use, self-monitoring and physical activity) on the present disease control perspective, and future lifespan perspective would be beneficial for the consistent self-management behaviours of middle-aged and older hypertensive patients. The utility of present disease control perception to these self-management behaviours was much higher than the utility of future expectations. Alternative stress relief strategies may be conducive to long-term changes in addictive behaviours.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12990-8.

Enhancing Outpatient Symptom Management in Patients With Head and Neck Cancer: A Qualitative Analysis

IMPORTANCE

Patients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge.

OBJECTIVE

To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment.

DESIGN, PARTICIPANTS, AND SETTING

This was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021.

MAIN OUTCOMES AND MEASURES

Patient perception of ambulatory symptom management and standardized symptom assessment.

RESULTS

Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on.

CONCLUSIONS AND RELEVANCE

This qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.

Age-related Differences in Recall of Information and Handling of Chemotherapy-related Side Effects in Cancer Patients: The ReCap Study

Background

To prevent severe toxicity and hospital admissions, adequate management and recall of information about side effects are crucial and health literacy plays an important role. If age-related factors impact recall of given information and handling of side effects, revised ways to give information are required.

Patients and Methods

We undertook a questionnaire-based survey among 188 newly diagnosed patients with pancreatic cancer or colorectal cancer and chemo-naive patients with prostate cancer treated with adjuvant or first-line palliative chemotherapy comprising satisfaction with given information, recall of potential side effects, and handling of hypothetical side effect scenarios. We evaluated the association between baseline characteristics, ie, age, frailty (G8 score), comorbidity (Charlson Comorbidity Index), cognitive function (Mini-Cog), satisfaction, recall of information, and handling of side effects.

Results

Reduced ability to recall information about several side effects (eg, chest pain) was associated with older age (odds ratio adjusted for cancer [aOR] 0.94 [95% CI, 0.88-0.98]) and poor cognitive screening (aOR 0.56 [95% CI, 0.33-0.91]). Insufficient or dangerous handling of side effects was associated with older age (aOR 0.96 (95% CI, 0.92-0.99)) and cognitive impairment (aOR 0.70 [95% CI, 0.50-0.95]).

Conclusion

Older age and poor cognitive screening may impact patients’ ability to understand and adequately handle chemotherapy-related side effects. Cognitive screening and focus on individual ways to give information including assessment of recall and handling are needed.

Health Literacy of Newly-Admitted Cancer Patients in Vietnam: Difficulties Understanding Treatment Options and Processing Health-Related Information

Having a good understanding of cancer patients' health literacy in the early stage of diagnosis can help to implement strategies to improve the management process and overall health outcomes. The study aims to describe health literacy and its association with socio-demographic characteristics among newly admitted cancer patients. A cross-sectional study was conducted on 262 newly admitted patients of a cancer hospital in Vietnam using the Vietnamese version of the HLS-SF12 questionnaire. Descriptive analytics and regression analysis were used to describe health literacy and examine associated factors. Older age, lower level of education, and living in rural areas were associated with lower health literacy while there was no significant relationship between gender and health literacy among newly admitted cancer patients. Many newly admitted patients, especially the older patients have difficulties understanding the different treatment options (54%) and evaluating the reliability of health information on the internet (43%). During the early stage of treatment, strategies should be implemented with regards to patients' health literacy, to properly educate patients and their caregivers to improve communication, adherence to medication, lifestyle, and overall better quality of life and treatment outcome.

The association of self-efficacy and health literacy to chemotherapy self-management behaviors and health service utilization

BACKGROUND

Increasing demands on Canada's healthcare system require patients to take on more active roles in their health. Effective self-management has been linked to improved health outcomes; and there is evidence that effective behaviors, and subsequent healthcare utilization, are linked to self-efficacy and health literacy; however, this link has had minimal testing in the cancer context. Our aim is to examine the association between self-efficacy, health literacy, chemotherapy self-management behaviors, and health service utilization.

DESIGN AND METHODS

A cross-sectional survey that included validated measures of self-efficacy, health literacy, chemotherapy self-management, and health service utilization was completed by participants (N = 213). Multivariable modeling using hierarchical linear regression was used to examine the association between variables.

RESULTS

Self-efficacy contributed significantly to explaining variation in chemotherapy self-management score. Health literacy was not significantly associated with any of the dependent variables.

CONCLUSION

Participants with higher self-efficacy had higher chemotherapy self-management scores compared to participants with low self-efficacy. Contrary to evidence in the chronic disease self-management literature, this study demonstrated that health literacy was not associated with chemotherapy self-management behavior nor was it associated with self-efficacy. Building patient self-efficacy in the context of chemotherapy self-management could be particularly helpful both in the cancer center and in the domain of oral chemotherapy management at home where patients are required to take on significant responsibility for self-management.

Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies

Guided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included quantitative descriptive studies that measured overall and subdomains of QOL as the outcome in adult patients/survivors with cancer in SSA. Twenty-six descriptive cross-sectional studies (27 papers) that were conducted since 1988 in different SSA countries among patients with various types of cancer met our inclusion criteria. We found inconsistencies in how the prevalence and severity of QOL-related health problems have been researched and reported across studies, which complicated comparing findings and drawing conclusions. The most common factors that influenced the overall and subdomains of QOL included coping; internal and external locus of control; symptoms and symptom management; and religious beliefs and religious care. Demographics (e.g., age and marital status), cancer-related factors (cancer stage and type of treatment), and social determinants of health (e.g., education, access to information and resources, financial distress, and urban vs rural residency) also impacted QOL and its subdomains. Our findings indicate the significant need for recognizing and managing QOL-related problems for cancer patients and caregivers in SSA. Research needs to use culturally adapted, standardized assessment tools and analysis approaches to better understand the QOL challenges this population faces. Comprehensive supportive care is needed to address the complex QOL issues in resource-limited SSA.

Organizational Health Literacy in a Hospital-Insights on the Patients' Perspective

Health literacy-sensitive communication has been found to be an important dimension of organizational health literacy measured from the patients' perspective. Little is known about the role of health literacy-sensitive communication in complex care structures. Therefore, our aim was to assess which hospital characteristics (in terms of process organization) and patient characteristics (e.g., age, chronic illness, etc.) contribute to better perceptions of health literacy-sensitive communication, as well as whether better health literacy-sensitive communication is associated with better patient reported experiences. Data were derived from a patient survey conducted in 2020 in four clinical departments of a university hospital in Germany. Health literacy-sensitive communication was measured with the HL-COM scale. Data from 209 patients (response rate 24.2%) were analyzed with a structural equation model (SEM). Results revealed that no patient characteristics were associated with HL-COM scores. Better process organization as perceived by patients was associated with significantly better HL-COM scores, and, in turn, better HL-COM scores were associated with more patient-reported social support provided by physicians and nurses as well as fewer unmet information needs. Investing into good process organization might improve health literacy-sensitive communication, which in turn has the potential to foster the patient-provider relationship as well as to reduce unmet information needs of patients.