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Lim B, Sen S. A cross-sectional quantitative analysis of the readability and quality of online resources regarding thumb carpometacarpal joint replacement surgery. J Hand Microsurg 2024; 16:100119. [PMID: 39234384 PMCID: PMC11369735 DOI: 10.1016/j.jham.2024.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 09/06/2024] Open
Abstract
Background Thumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition that affects up to 15 % of the population older than 30 years. Poor readability of online health resources has been associated with misinformation, inappropriate care, incorrect self-treatment, worse health outcomes, and increased healthcare resource waste. This study aims to assess the readability and quality of online information regarding thumb carpometacarpal (CMC) joint replacement surgery. Methods The terms "thumb joint replacement surgery", "thumb carpometacarpal joint replacement surgery", "thumb cmc joint replacement surgery", "thumb arthroplasty", "thumb carpometacarpal arthroplasty", and "thumb cmc arthroplasty" were searched in Google and Bing. Readability was determined using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Reading Grade Level (FKGL). FRES >65 or a grade level score of sixth grade and under was considered acceptable. Quality was assessed using the Patient Education Materials Assessment Tool (PEMAT) and a modified DISCERN tool. PEMAT scores below 70 were considered poorly understandable and poorly actionable. Results A total of 34 websites underwent qualitative analysis. The average FRES was 54.60 ± 7.91 (range 30.30-67.80). Only 3 (8.82 %) websites had a FRES score >65. The average FKGL score was 8.19 ± 1.80 (range 5.60-12.90). Only 3 (8.82 %) websites were written at or below a sixth-grade level. The average PEMAT percentage score for understandability and actionability was 76.82 ± 9.43 (range 61.54-93.75) and 36.18 ± 24.12 (range 0.00-60.00) respectively. Although 22 (64.71 %) of websites met the acceptable standard of 70 % for understandability, none of the websites met the acceptable standard of 70 % for actionability. The average total DISCERN score was 32.00 ± 4.29 (range 24.00-42.00). Conclusions Most websites reviewed were written above recommended reading levels. Most showed acceptable understandability but none showed acceptable actionability. To avoid the negative outcomes of poor patient understanding of online resources, providers of these resources should optimise accessibility to the average reader by using simple words, avoiding jargon, and analysing texts with readability software before publishing the materials online. Websites should also utilise visual aids and provide clearer pre-operative and post-operative instructions.
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Affiliation(s)
- Brandon Lim
- Trinity College Dublin, School of Medicine, Dublin, Ireland
| | - Suddhajit Sen
- Department of Trauma and Orthopaedic Surgery, Raigmore Hospital, Inverness, UK
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2
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Del Risco A, Cherches A, Polcaro L, Washabaugh C, Hales R, Jiang R, Allori A, Raynor E. Improving Health Literacy of Elective Procedures in Pediatric Otolaryngology. Otolaryngol Head Neck Surg 2024; 171:546-553. [PMID: 38520236 DOI: 10.1002/ohn.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To identify if the addition of supplementary material, such as video or written resources, to the consent process, can improve a patient's or guardian's health literacy in pediatric otolaryngology. STUDY DESIGN Prospective randomized crossover design. SETTING Tertiary Academic Center. METHODS From April 18, 2022 to August 29, 2023, 151 children scheduled to undergo 1 of 6 procedures by the same provider were queried and completed a 6-question baseline test based on the information. They each watched a 2-minute video and read a written summary about the procedure; the order of resources was randomized. They answered the same 6-questions after viewing each resource. All tests were scored based on accuracy using an ordinal scale of 1 to 6. Resource preference was collected. Wilcoxon signed-rank tests were run to analyze differences in scores after the addition of supplementary resources and logistic regression modeling was run to analyze demographic effects on postresource score differences. RESULTS Of 151 participants, 74.2% were guardians, with 78.8% having completed a high school or greater education. The Wilcoxon signed-rank test indicated that postresource scores were statistically significantly higher (P < .001) than pretest scores. Logistic regression modeling showed that participants were less likely to show score improved if they were younger than 18 and were of white race. A majority (87.4%) preferred the addition of a video to the consent process. CONCLUSION The addition of video or written resources significantly improves understanding of elective procedures. The development of procedure-specific resources can supplement the consent process and ensure decision-makers have adequate health literacy for informed decision-making.
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Affiliation(s)
- Amanda Del Risco
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Cherches
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Polcaro
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Claire Washabaugh
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robin Hales
- Department of Child Life, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rong Jiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Allori
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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3
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Mirzaie AA, Hanson NC, Neal D, Berceli SA, Back MR, Scali ST, Huber TS, Upchurch GR, Shah SK. Limited health literacy is common among vascular surgery patients. Surgery 2024; 175:1600-1605. [PMID: 38461121 DOI: 10.1016/j.surg.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Health literacy is a crucial aspect of informed decision-making, and limited health literacy has been associated with worse health care outcomes. To date, health literacy has not been examined in vascular surgery patients. Therefore, we conducted a prospective observational study to determine the prevalence and factors associated with poor health literacy in vascular surgery patients. METHODS The Newest Vital Sign (Pfizer, New York, NY), a validated instrument, was used to appraise the health literacy of 150 patients who visited the outpatient vascular clinic at UF Health Shands Hospital between April 2022 and August 2022. Patients who scored a 4 (out of 6) or higher were classified as having adequate health literacy. Each study participant also completed a sociodemographic questionnaire. RESULTS In total, 82 out of the 150 (54%) patients we screened had limited health literacy. The prevalence of limited health literacy varied and was independently associated with increased age (odds ratio 1.06; 95% [1.02 to 1.10], P = .004), having not attended college (high school diploma versus college+ odds ratio 3.5; 95% [1.26 to 10.1], P = .018), and African American race (odds ratio 5.3; 95% [1.59 to 22.3], P = .012). A total of 83% of African American patients had limited health literacy, compared to 49% of Asian and White patients. CONCLUSION Most vascular surgery patients have limited health literacy. Increased age, fewer years of education, and African American race were associated with limited health literacy. Physicians caring for patients with lower health literacy should investigate and use communication strategies tailored to patients with limited health literacy.
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Affiliation(s)
- Amin A Mirzaie
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Nancy C Hanson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Dan Neal
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Samir K Shah
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL.
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Machado PT, Lecoultre C, Courbon C. Cross-sectional and Correlational Examination of Patients' Preoperative Anxiety, Information Need, and Health Literacy in a Presurgical Consultation. J Perianesth Nurs 2024:S1089-9472(24)00039-X. [PMID: 38762807 DOI: 10.1016/j.jopan.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This study elucidates the preoperative anxiety (PA), information need (IN), and health literacy (HL) levels of an elective preoperative sample in Switzerland and examines the possible associations between PA and the patients' characteristics. By knowing these patient dimensions, which can influence perioperative outcomes, one can tailor individualized nursing interventions to improve patients' surgical experience. DESIGN This was a cross-sectional and correlational study. METHODS The sample consisted of 88 patients who underwent a preoperative consultation at a Swiss tertiary hosptial. Patients' PA and IN were assessed using the Anxiety Preoperative and Information Scale, and their HL was measured using the Functional, Communicative, and Critical Health Literacy Scale. Data on other patient characteristics were collected from the patients, physicians, and electronic patient records. Association tests, as well as univariate regressions, were performed on PA, IN, HL, and patient characteristics. FINDINGS Among participants, 40.91%, 78.41%, and 59% reported having PA, IN, and low HL, respectively. Finally, PA was associated with IN, HL, solitary living, and the American Society of Anesthesiology score. CONCLUSIONS A high proportion of patients scheduled for presurgical consultation were found to be anxious. They presented high IN and low HL. An examination of patients' PA-associated characteristics can help improve their surgical experience. More studies should examine PA-associated characteristics.
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Affiliation(s)
| | - Claudia Lecoultre
- Department of Surgery and Vascular Cardiology Services, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Cécile Courbon
- Department of Surgery and Vascular Cardiology Services, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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Keles A, Kose M, Somun UF, Culpan M, Yaksi N, Yıldırım A. Impact of health and digital health literacy on quality of life following radical prostatectomy for prostate cancer: prospective single-center cohort study. World J Urol 2024; 42:241. [PMID: 38632212 PMCID: PMC11024042 DOI: 10.1007/s00345-024-04960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The importance of health literacy (HL) and digital health literacy (e-HL) in promoting healthy behavior and informed decision making is becoming increasingly apparent. This study aimed to assess the effects of HL and e-HL on the quality of life (QoL) of men who underwent radical prostatectomy (RP) for localized prostate cancer. MATERIALS AND METHODS This prospective observational study included 104 patients who underwent RP for localized prostate cancer. HL and e-HL were evaluated using the validated eHealth Literacy Scale and European Health Literacy Survey Questionnaire Short Form before RP. We evaluated patients' physical, psychological, social, and global QoL using the validated EORTC QLQ-C30 8 weeks after RP. The exclusion criterion was any difficulties in language and comprehension. We employed one-way ANOVA to compare continuous variables across groups in univariate analysis and used MANOVA for exploring relationships among multiple continuous variables and groups in the multivariate analysis. RESULTS Multivariate analyses showed that poorer e-HL and HL were associated with being older (p = 0.019), having less education (p < 0.001), and not having access to the internet (p < 0.001). Logistic regression analysis revealed significant associations between improved e-HL (p = 0.043) and HL (p = 0.023), better global health status, and higher emotional functioning (p = 0.011). However, the symptom scales did not differ significantly between the e-HL and HL groups. CONCLUSION Our study showed a positive association between self-reported HL/e-HL and QoL, marking the first report on the impact of HL/e-HL on the QoL in men who underwent RP for clinically localized prostate cancer.
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Affiliation(s)
- Ahmet Keles
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Muhammed Kose
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Umit Furkan Somun
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nese Yaksi
- Department of Public Health, School of Medicine, University of Amasya, Amasya, Turkey
| | - Asıf Yıldırım
- Department of Urology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Bettis T, Lewis M, Wang R, Gillis A, Zmijewski P, McLeod M, Fazendin J, Lindeman B, Chen H. An Evaluation of Health Literacy in Patients Undergoing Surgical Evaluation for Thyroid Disease. J Surg Res 2024; 295:81-88. [PMID: 37995419 DOI: 10.1016/j.jss.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/04/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Health literacy (HL) is the ability to comprehend and apply health information to make informed health-care decisions. Poor HL results in the inability to provide informed consent, medication noncompliance, inconsistent follow-up, and delayed seeking of care. Data about HL in endocrine surgery is currently lacking. In this study, we aimed to evaluate the HL of patients with thyroid disease and identify risk factors for limited HL. METHODS We evaluated a total of 172 patients with thyroid disease in a single endocrine surgery clinic. HL was determined by the Brief Health Literacy Screening Tool, a validated HL screening questionnaire in which patient scores correlate to limited, marginal, or adequate HL. Demographic data including age, sex, race, diagnosis, employment status, and median annual income were obtained. Analysis of variance, t-test, and Chi-square test were used to compare HL between and within each demographic domain. P < 0.05 was considered significant. RESULTS Of the 172 patients, 77% had adequate HL, 16% had marginal HL, and 7% had limited HL. Patients with higher education exhibited greater HL (P < 0.001). Ninety-three percent of patients with college/postgraduate degree had adequate HL, while of those with some college only 79% had adequate HL and of those with high school or less only 48.6% had adequate HL. There was minimal variation among age, sex, race, diagnosis, employment status, or income. CONCLUSIONS Most patients with thyroid diseases from the endocrine surgery clinic at our institution have adequate HL. Limited education is a risk factor for low HL.
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Affiliation(s)
- Tucker Bettis
- University of Alabama at Birmingham, Birmingham, Alabama.
| | - Marshall Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronghzi Wang
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea Gillis
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Herbert Chen
- University of Alabama at Birmingham, Birmingham, Alabama
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7
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Spencer KA, Wahlstedt ER, Upton KE, Bylund JR, Bell JR. Any Questions? Understanding the Functional Health Literacy in Patients Who Underwent Ureteroscopy. Urology 2024; 183:39-45. [PMID: 37926383 PMCID: PMC11178141 DOI: 10.1016/j.urology.2023.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To correlate health literacy of patients undergoing ureteroscopy and identify gaps within current patient education practices in order to better tailor the preoperative experience. METHODS Eighteen patients were retrospectively recruited to complete an in-depth semistructured interview and the Test of Functional Health Literacy for Adults (TOFHLA). All interviews were recorded, transcribed, and then coded and analyzed using the grounded theory of analysis. RESULTS The average participant age was 56.2 ± 12.8years, and 10 (55.6%) identified as female. Education level ranged from some high school to a professional degree. The average TOFHLA score was 88.1 ± 11.7. Irrespective of score, all participants felt they understood the purpose and basic elements of a ureteroscopy. The use of nontechnical language, repetition, and previous healthcare experiences were identified as positive aspects of the education experience. However, 72.2% (n = 13) identified the primary gap in understanding revolved around the use, purpose, and pain associated with stents. CONCLUSION Functional health literacy is an essential element, but not the only factor informing patient education and comprehension. Current practices are effective in explaining the basics of a ureteroscopy, but even when identified health literacy is higher than expected, a gap remains in stent education. Efforts should be made to better understand how stents can be effectively explained to patients in addition to continuing to refine education practices to elicit true comprehension.
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Affiliation(s)
| | | | | | - Jason R Bylund
- University of Kentucky, Department of Urology, Lexington, KY
| | - John Roger Bell
- University of Kentucky, Department of Urology, Lexington, KY
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Trutner ZD, Furlough K, Martinez A, Vetter I, Uhler LM, Haynes A, Jayakumar P. Is Health Literacy Associated With Surgical Outcomes? A Systematic Review. J Surg Res 2023; 291:720-733. [PMID: 37572516 DOI: 10.1016/j.jss.2023.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Low levels of health literacy have been shown to increase healthcare utilization and negatively affect health outcomes within medical specialties. However, the relationship of health literacy with clinical, patient-centered, and process-oriented surgical outcomes is not as well understood. MATERIALS AND METHODS We sought to systematically review the current evidence base regarding the relationship between health literacy and a range of outcomes in patients experiencing surgical care. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched six databases and then identified and extracted data from 25 cross-sectional or cohort studies deemed eligible for a systematic review. RESULTS Among included studies, strong evidence exists to support an association between low health literacy and worse patient-centered outcomes, as well as an association between low health literacy and poorer process-oriented surgical outcomes. However, the relationship between health literacy and clinical outcomes remains unclear. CONCLUSIONS Substantial opportunities remain to improve our understanding of the impact of health literacy on surgical outcomes. Future work should expand the range of institutional and specialized surgical settings studied, implement a standardized set of validated health literacy assessment tools, include more diverse patient populations, and investigate a comprehensive range of patient-reported outcomes.
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Affiliation(s)
- Zoe D Trutner
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas.
| | - Kenneth Furlough
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Anuska Martinez
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Imelda Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Lauren M Uhler
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Alex Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Wang SM, Njoroge MW, Mundy LR, Sergesketter AR, Stukes B, Shammas RL, Langdell HC, Geng Y, Hollenbeck ST. Evaluating Disparities in Pathways to Breast Reconstruction. J Reconstr Microsurg 2023; 39:671-680. [PMID: 37023769 DOI: 10.1055/s-0043-1764486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Rates of postmastectomy breast reconstruction have been shown to vary by racial, ethnic, and socioeconomic factors. In this study, we evaluated disparities across pathways toward breast reconstruction. METHODS All women who underwent mastectomy for breast cancer at a single institution from 2017 to 2018 were reviewed. Rates of discussions about reconstruction with breast surgeons, plastic surgery referrals, plastic surgery consultations, and ultimate decisions to pursue reconstruction were compared by race/ethnicity. RESULTS A total of 218 patients were included, with the racial/ethnic demographic of 56% white, 28% Black, 1% American Indian/Native Alaskan, 4% Asian, and 4% Hispanic/Latina. The overall incidence of postmastectomy breast reconstruction was 48%, which varied by race (white: 58% vs. Black: 34%; p < 0.001). Plastic surgery was discussed by the breast surgeon with 68% of patients, and referrals were made in 62% of patients. While older age (p < 0.001) and nonprivate insurance (p < 0.05) were associated with lower rates of plastic surgery discussion and referral, it did not vary by race/ethnicity. The need for an interpreter was associated with lower rates of discussion (p < 0.05). After multivariate adjustment, a lower reconstruction rate was associated with the Black race (odds ratio [OR] = 0.33; p = 0.014) and body mass index (BMI) ≥ 35 (OR = 0.14; p < 0.001). Elevated BMI did not disproportionately lower breast reconstruction rates in Black versus white women (p = 0.27). CONCLUSION Despite statistically equivalent rates of plastic surgery discussions and referrals, black women had lower breast reconstruction rates versus white women. Lower rates of breast reconstruction in Black women likely represent an amalgamation of barriers to care; further exploration within our community is warranted to better understand the racial disparity observed.
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Affiliation(s)
- Sabrina M Wang
- Duke University School of Medicine, Durham, North Carolina
| | | | - Lily R Mundy
- Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Amanda R Sergesketter
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Bryanna Stukes
- Duke University School of Medicine, Durham, North Carolina
| | - Ronnie L Shammas
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Hannah C Langdell
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | | | - Scott T Hollenbeck
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
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Raso J, Kamalapathy PN, Sumpter A, Ramamurti P, Werner BC. Economic and educational disparities are associated with an increased risk of revision surgery following shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:589-596. [PMID: 36179962 DOI: 10.1016/j.jse.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/23/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is limited literature exploring how nonmedical factors such as social determinants of health (SDOHs) are associated with postoperative outcomes following shoulder arthroplasty. METHODS A retrospective cohort review of the Pearl Diver Database was used to capture patients undergoing either primary anatomic total or reverse shoulder arthroplasty from the fourth quarter of 2015 to the third quarter of 2019 with at least 1 year of active longitudinal follow-up. Patients with proximal humeral fractures, stress fractures, or septic arthritis were excluded. The included patients were then divided into 2 cohorts based on the presence of current SDOHs or a history of SDOHs. The SDOH cohort comprised 4 non-mutually exclusive categories: economic, educational, social, and environmental disparities. Subsequently, a control cohort was matched at a 1:1 ratio to the SDOH cohort. Primary outcome measures were assessed using a logistic regression and consisted of the following 90-day postoperative complications: minor and major medical complications and infection. Emergency department (ED) visits and readmissions for any cause were also assessed. Additionally, the following 1-year outcomes were assessed: aseptic loosening, instability, and revision arthroplasty. Surgical costs and 90-day postoperative costs were collected using averaged insurance reimbursements for both the control and SDOH cohorts. RESULTS There were 5190 patients in each cohort. Economic disparities made up the largest portion of the SDOH cohort (n = 4631, 89.2%), followed by social (n = 741, 14.3%), environmental (n = 417, 8.0%), and educational (n = 99, 1.9%) disparities. Compared with the control cohort, SDOHs were associated with an increased risk of major complications (2.3% vs. 1.4%; odds ratio [OR], 1.55; 95% confidence interval [CI], 1.29-1.87; P < .001), minor complications (5.7% vs. 3.8%; OR, 1.62; 95% CI, 1.21-1.95; P = .001), readmissions (4.3% vs. 2.8%; OR, 1.56; 95% CI, 1.26-1.84; P < .001), and ED visits (15.2% vs. 11.0%; OR, 1.45; 95% CI, 1.29-1.63; P < .001) within 90 days following surgery. Additionally, SDOHs were associated with an increased risk of aseptic loosening (1.1% vs. 0.6%; OR, 1.85; 95% CI, 1.20-2.65; P = .006), instability (4.0% vs. 2.2%; OR, 1.80; 95% CI, 1.43-2.28; P < .001), and ipsilateral revision (9.2% vs. 7.6%; OR, 1.24; 95% CI, 1.08-1.43; P < .001) at 1 year postoperatively compared with the control cohort. CONCLUSION SDOHs are associated with increased rates of adverse outcomes following shoulder arthroplasty including revision surgery, ED visits, length of stay, and overall cost compared with matched controls without SDOHs. Specifically, economic and educational disparities are associated with increased rates of adverse outcomes following surgery including revision surgery, ED visits, length of stay, and overall cost.
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Affiliation(s)
- Jon Raso
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Anna Sumpter
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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11
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Readability of Online Patient Education Materials for Total Joint Arthroplasty: A Systematic Review. J Arthroplasty 2023:S0883-5403(23)00052-9. [PMID: 36716898 DOI: 10.1016/j.arth.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND As the demand for total joint arthroplasty continues to grow, patients increasingly turn to internet sources for accessible orthopaedic health information. We sought to evaluate the readability of online hip and knee arthroplasty patient education materials (PEMs). METHODS Our systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P guidelines (PROSPERO registration of the study protocol: CRD42022358872, September 19th, 2022). PubMed, EBSCOhost, Medline, and Google Scholar electronic databases were utilized to identify all studies evaluating online PEMs related to total joint arthroplasty between January 1, 2000, and August 1, 2022. The quality of studies was assessed with the Joanna Briggs Institute scale. RESULTS Our initial search yielded 360 publications which were then screened for appropriate studies aligned with our review's purpose. A total of eleven cross-sectional studies were included. The total sample size across the studies consisted of 662 PEMs. Five studies evaluated professional or academic orthopaedic websites, six evaluated PEMs through web engines, and three evaluated apps or commercial websites. Most included studies found PEMs to be well above the recommended 6th-grade reading level. CONCLUSION Arthroplasty PEMs produced by orthopaaedic websites, web searches, and apps have readability scores well above the recommended levels. Given the importance of health literacy on patient outcomes and satisfaction, work needs to be done to improve the readability of these materials.
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Haider SF, Ma S, Xia W, Wood KL, Matabele MM, Quinn PL, Merchant AM, Chokshi RJ. Racial disparities in minimally invasive esophagectomy and gastrectomy for upper GI malignancies. Surg Endosc 2022; 36:9355-9363. [PMID: 35411463 DOI: 10.1007/s00464-022-09210-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Esophageal cancer and gastric cancer are two important causes of upper GI malignancies. Literature has shown that minimally invasive esophagectomies (MIE) and gastrectomies (MIG), have shorter length of stay and fewer complications. However, limited literature exists about the association between race and access to MIE and MIG. This study aims to identify the racial disparities in the different approaches to esophagectomy and gastrectomy. We further evaluate the relationship between the race and postoperative complications. METHODS This IRB-approved retrospective study utilized data from the American College of Surgeons National Quality Improvement Program. All recorded cases of MIE, MIG, open gastrectomy, and esophagectomy between 2012 and 2019 were isolated. Propensity score matching and univariate analysis was performed to assess the independent effect of black self-identified race on access and outcomes. p < 0.05 was required to achieve statistical significance. RESULTS 7891 cases of esophagectomy and 5,132 cases of gastrectomy cases were identified. Using Propensity and logistic regression, we identified that black self-reported race is an independent predictor of open approach to gastrectomy (OR 1.6871943, 95% CI 1.431464-1.989829, p < 0.001). Black self-reported race was not predictive of operative approach among esophagectomy patients (OR 0.7942576, 95% CI 0.5698645-1.124228, p = 0.183). In contrast, black self-reported is an independent predictor of postoperative complications among esophagectomy patients only. Esophagectomy patients of black self-reported race were more likely to experience any complication (OR 1.4373437, 95% CI 1.1129239-1.8557096, p = 0.00537), severe complications (OR 1.3818966, 95% CI 1.0653087-1.7888454, p = 0.0144), and death (OR 2.00779762, 95% CI 1.08034921-3.56117535, p = 0.0211) within 30 days of their surgeries. CONCLUSION Our analysis revealed a significant racial disparity in access to MIG and a higher incidence of post-operative complications amongst esophagectomy patients. Minimally invasive techniques are underutilized in racial minorities. The findings herein warrant further investigation to eliminate barriers and disparities.
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Affiliation(s)
- Syed F Haider
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, Newark, NJ, F122207103, USA.
| | - Sirui Ma
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, Newark, NJ, F122207103, USA
| | - Weiyi Xia
- Department of Public Health, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Kasey L Wood
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mario M Matabele
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Patrick L Quinn
- Department of Surgery, Ohio State College of Medicine, Columbus, OH, USA
| | - Aziz M Merchant
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, Newark, NJ, F122207103, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, Newark, NJ, F122207103, USA
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Driessens H, van Wijk L, Buis CI, Klaase JM. Low health literacy is associated with worse postoperative outcomes following hepato-pancreato-biliary cancer surgery. HPB (Oxford) 2022; 24:1869-1877. [PMID: 35927128 DOI: 10.1016/j.hpb.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low health literacy (HL) can lead to worse health outcomes for patients with chronic diseases and could also lead to worse postoperative outcomes. This retrospective cohort study investigates the association between HL and postoperative textbook outcome (TO) after hepato-pancreato-biliary (HPB) cancer surgery. METHODS Patients that consented and underwent surgery for a premalignant andmalignant HPB tumor were included. Preoperatively, HL was measured by the brief health literacy screen (BHLS). Patients were categorized as having low or adequate HL. Primary outcome was TO (length of hospital stay (LOS) ≤ 75th percentile; and no severe complication; and no readmission and mortality within 30 days after discharge). Secondary outcomes were LOS and emergency department (ED) visits within 30 days after discharge. RESULTS In total, 137 patients were included, of whom thirty-six patients had low HL. In patients with low HL (vs. adequate HL), rate of TO was lower (55.6% vs. 72.3%; p = 0.095), LOS was significantly longer (13.5 vs. 9 days; p = 0.007) and there was only a slight difference in ED visits (14.3% vs. 11.0%; p = 0.560). Patients with low HL had a significant lower chance of achieving TO (OR 0.400, 95%-CI 0.169-0.948; p = 0.037). CONCLUSION Low HL leads to worse postoperative outcome after HPB cancer surgery. Better preoperative education and guidance of patients with low HL could lead to better postoperative outcomes. Therefore, HL could be the next modifiable risk factor before major surgery.
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Affiliation(s)
- Heleen Driessens
- University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, the Netherlands.
| | - Laura van Wijk
- University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, the Netherlands
| | - Carlijn I Buis
- University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, the Netherlands
| | - Joost M Klaase
- University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, the Netherlands
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Social Determinants of Health Disparities are Associated with Increased Costs, Revisions, and Infection in Patients Undergoing Arthroscopic Rotator Cuff Repair. Arthroscopy 2022; 39:673-679.e4. [PMID: 37194108 DOI: 10.1016/j.arthro.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/23/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to use a national claims database to assess the impact of pre-existing social determinants of health disparities (SDHD) on postoperative outcomes following rotator cuff repair (RCR). METHODS A retrospective review of the Mariner Claims Database was used to capture patients undergoing primary RCR with at least 1 year of follow-up. These patients were divided into two cohorts based on the presence of a current or previous history of SDHD, encompassing educational, environmental, social, or economic disparities. Records were queried for 90-day postoperative complications, consisting of minor and major medical complications, emergency department (ED) visits, readmission, stiffness, and 1-year ipsilateral revision surgery. Multivariate logistic regression was employed to assess the impact of SDHD on the assessed postoperative outcomes following RCR. RESULTS 58,748 patients undergoing primary RCR with a SDHD diagnosis and 58,748 patients in the matched control group were included. A previous diagnosis of SDHD was associated with an increased risk of ED visits (OR 1.22, 95% CI 1.18-1.27; P < .001), postoperative stiffness (OR 2.53, 95% CI 2.42-2.64; P < .001), and revision surgery (OR 2.35, 95% CI 2.13-2.59; P < .001) compared to the matched control group. Subgroup analysis revealed educational disparities had the greatest risk for 1-year revision (OR 3.13, 95% CI 2.53-4.05; P < .001). CONCLUSIONS The presence of a SDHD was associated with an increased risk of revision surgery, postoperative stiffness, emergency room visits, medical complications, and surgical costs following arthroscopic RCR. Overall, economic and educational SDHD were associated with the greatest risk of 1-year revision surgery. LEVEL OF EVIDENCE III, retrospective cohort study.
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Ó Doinn T, Broderick JM, Clarke R, Hogan N. Readability of Patient Educational Materials in Sports Medicine. Orthop J Sports Med 2022; 10:23259671221092356. [PMID: 35547607 PMCID: PMC9082750 DOI: 10.1177/23259671221092356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background The internet has become an increasingly popular resource among sports medicine patients seeking injury-related information. Numerous organizations recommend that patient educational materials (PEMs) should not exceed sixth-grade reading level. Despite this, studies have consistently shown the reading grade level (RGL) of PEMs to be too demanding across a range of surgical specialties. Purpose To determine the readability of online sports medicine PEMs. Study Design Cross-sectional study. Methods The readability of 363 articles pertaining to sports medicine from 5 leading North American websites was assessed using 8 readability formulas: Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, Raygor Estimate, Fry Readability Formula, Simple Measure of Gobbledygook, Coleman-Liau Index, FORCAST Readability Formula, and Gunning Fog Index. The mean RGL of each article was compared with the sixth- and eighth-grade reading level in the United States. The cumulative mean website RGL was also compared among individual websites. Results The overall cumulative mean RGL was 12.2 (range, 7.0-17.7). No article (0%) was written at a sixth-grade reading level, and only 3 articles (0.8%) were written at or below the eighth-grade reading level. The overall cumulative mean RGL was significantly higher than the sixth-grade [95% CI for the difference, 6.0-6.5; P < .001] and eighth-grade (95% CI, 4.0-4.5; P < .001) reading levels. There was a significant difference among the cumulative mean RGLs of the 5 websites assessed. Conclusion Sports medicine PEMs produced by leading North American specialty websites have readability scores that are above the recommended levels. Given the increasing preference of patients for online health care materials, the imperative role of health literacy in patient outcomes, and the growing body of online resources, significant work needs to be undertaken to improve the readability of these materials.
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Affiliation(s)
- Tiarnán Ó Doinn
- Department of Trauma and Orthopaedic Surgery, St. James’s Hospital, Dublin, Ireland
| | - James M. Broderick
- Department of Trauma and Orthopaedic Surgery, St. James’s Hospital, Dublin, Ireland
| | - Rebecca Clarke
- Department of Trauma and Orthopaedic Surgery, St. James’s Hospital, Dublin, Ireland
| | - Niall Hogan
- Department of Trauma and Orthopaedic Surgery, St. James’s Hospital, Dublin, Ireland
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Rainey R, Theiss L, Lopez E, Wood T, Wood L, Marques I, Cannon JA, Kennedy GD, Morris MS, Hollis R, Davis T, Chu DI. Characterizing the impact of verbal communication and health literacy in the patient-surgeon encounter. Am J Surg 2022; 224:943-948. [PMID: 35527045 DOI: 10.1016/j.amjsurg.2022.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients with limited health literacy (HL) have difficulty understanding written/verbal information. The quality of verbal communication is not well understood. Therefore, our aim was to characterize patient-surgeon conversations and identify opportunities for improvement. METHODS New colorectal patient-surgeon encounters were audio-recorded and transcribed. HL was measured. Primary outcomes were rates-of-speech, understandability of words, patient-reported understanding, and usage of medical jargon/statistics. Secondary outcomes included length-of-visit (LOV), conversation possession time, patient-surgeon exchanges, and speech interruptions. RESULTS Significant variations existed between surgeons in rates-of-speech and understandability of words (p < 0.05). Faster rates-of-speech were associated with significantly less understandable words (p < 0.05). Patient-reported understanding varied by HL and by surgeon. Conversation possession time and usage of medical jargon/statistics varied significantly by surgeon (p < 0.05) in addition to patient-surgeon exchanges and interruptions. Patients with limited HL had shorter LOV. CONCLUSIONS Significant variations exist in how surgeons talk to patients. Opportunities to improve verbal communication include slowing speech and using more understandable words.
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Affiliation(s)
- Rachael Rainey
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Lauren Theiss
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Elizabeth Lopez
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Tara Wood
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Lauren Wood
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Isabel Marques
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Jamie A Cannon
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Gregory D Kennedy
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Melanie S Morris
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Robert Hollis
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA
| | - Terry Davis
- Departments of Medicine and Pediatrics, Louisiana State University Health, Shreveport, LA, USA
| | - Daniel I Chu
- Department of Surgery, The University of Alabama at Birmingham, Division of Gastrointestinal Surgery, USA.
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Perez NP, Ahmad H, Alemayehu H, Newman EA, Reyes-Ferral C. The impact of social determinants of health on the overall wellbeing of children: A review for the pediatric surgeon. J Pediatr Surg 2022; 57:587-597. [PMID: 34893308 DOI: 10.1016/j.jpedsurg.2021.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023]
Abstract
Disparities in health care access, quality, and outcomes for pediatric patients, and their relationship to race and socioeconomic status (SES) have been extensively documented. The underlying causes behind such disparities have been less carefully studied, as clinicians and researchers often fail to look past immutable features such as race, into modifiable factors like social determinants of health (SDOH). A child's environment affects their patterns of social engagement, sense of security, and overall well-being. Resources such as affordable housing, access to education, public safety, and availability of healthy foods and safe play spaces impact and enhance quality of life, and have significant influence on both health and health care outcomes. These upstream indicators are often unrecognized or misidentified as health concerns. Few pediatric surgery publications discuss SDOH and their effects on children. This paper aims to introduce the five domains of SDOH (economic stability, education, social and community context, health and healthcare, and neighborhood and built environment) along with strategies to identify and address needs in these domains from a provider, hospital, and health system's perspective. It is anticipated that this information will serve as a foundation for pediatric surgeons to understand and develop processes that ameliorate disparities related to SDOH and improve surgical outcomes and the well-being of all children.
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Affiliation(s)
- Numa P Perez
- Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St GRB-425, Boston, MA 02114, United States.
| | - Hira Ahmad
- Department of Surgery, Nationwide Children's Hospital, Columbus, The Ohio State University College of Medicine, OH, United States
| | - Hanna Alemayehu
- Department of Surgery, Children's and Women's Hospital, University of South Alabama Health System, Mobile, AL, United States
| | - Erika A Newman
- Department of Surgery, CS Mott Children's Hospital, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia Reyes-Ferral
- Department of Surgery, St. Joseph's Children's Hospital, Tampa, FL, United States
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Bhalla RG, Furuyama W, Calvert JK, Ball M, Dropkin BM, Milam DF, Kaufman MR, Johnsen NV. Impact of Health Literacy on Satisfaction Following Male Prosthetic Surgery. Urology 2022; 164:255-261. [PMID: 35120965 DOI: 10.1016/j.urology.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a patient's health literacy impacts patient satisfaction following inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) placement. METHODS A retrospective study of patients who underwent IPP or AUS between January 1st 2016 and July 31st 2020 was performed. A telephone questionnaire assessed overall satisfaction and if patients would undergo surgery again. Health literacy was measured using the Brief Health Literacy Screen (BHLS). Multivariate ordinal logistic regression was used to assess the association between health literacy and patient satisfaction. RESULTS At a median follow up of 2.4 years, 113 (70%) of the 162 IPP patients were either satisfied or very satisfied with their procedure and 120 (74%) patients would undergo surgery again. Of the 76 AUS patients, 65 (86%) were either satisfied or very satisfied with their procedure and 65 (86%) patients would undergo surgery again. After adjustment for potential confounders, increasing BHLS score was significantly associated with satisfaction for both IPP (OR 1.31, 95% CI 1.11-1.54; p=0.001) and AUS surgery (OR 1.25, 95% CI 1.02-1.56; p=0.034), as well as with likelihood of undergoing IPP surgery again (OR 1.53, 95% CI 1.25-1.87; p<0.001). BHLS was not associated, however, with likelihood of undergoing AUS surgery again (p=0.403). CONCLUSIONS Men with lower health literacy are less likely to be satisfied following prosthetic surgery. The BHLS is an important tool that can be used to identify patients who may benefit from increased preoperative counseling to improve patient expectations and quality of life following prosthetic surgery.
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Key Words
- AUASI, American Urological Association symptom index
- AUS, Artificial urinary sphincter
- BHLS, Brief health literacy screen
- BMI, Body mass index
- Heath literacy, quality of life, men's health, penile prosthesis, artificial urinary sphincter. Key of Definitions for Abbreviations, AUA, American Urological Association
- IPP, Inflatable penile prosthesis
- PPD, Pads per day
- SHIM, Sexual health inventory for men;QOL, Quality of life
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Affiliation(s)
- Rohan G Bhalla
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - William Furuyama
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua K Calvert
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Douglas F Milam
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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Murphy B, Irwin S, Condon F, Kennedy C. Readability and quality of online information for patients pertaining to revision knee arthroplasty: An objective analysis. Surgeon 2022; 20:e366-e370. [PMID: 35034835 DOI: 10.1016/j.surge.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/25/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Modern patients use the internet more frequently for their health information. Our aim was to assess the quality and readability of online patient education materials relating to revision knee arthroplasty. We hypothesised that this information would be too difficult to read for the average patient and of a lesser quality than desired. METHOD A search of the top 50 results on 3 search engines (Google, Bing, Yahoo) was completed (MeSH "revision knee arthroplasty", "revision knee replacement"). Readability of these websites was calculated using a specialised website, www.readable.com to produce 3 scores (Gunning-Fog (GF), Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG). Quality was assessed using the Journal of American Medical Association (JAMA) benchmark criteria and the Health On the Net (HON) code toolbar extension. RESULTS 89 unique websites were identified. Mean FRE was 44.01 ± 11.05. The mean GF was 12.01 ± 2.94. The mean FKG level was 10.06 ± 1.95. As per the FRE score, no webpage was pitched at or below a sixth grade reading level. The GF index identified only 3 websites (3.4%) at 6th grade reading level. As per FKG score, most webpages (n = 58, 65.2%) found themselves in the 10th grade reading level and above. Four websites (4.5%) displayed a HONcode certificate. However, all had expired. Most websites (n = 34, 38.2%) didn't meet any of the JAMA criteria. CONCLUSION The reading level of these materials is too high for the average patient and of a low quality. Given what we know about levels of health literacy and their relationship with patient outcomes, it is vital that we address these deficiencies promptly.
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Affiliation(s)
- Ben Murphy
- University Hospital Limerick, Dooradoyle, Co. Limerick, Republic of Ireland; Croom Orthopaedic Hospital, Croom, Co. Limerick, Republic of Ireland.
| | - Shane Irwin
- University Hospital Limerick, Dooradoyle, Co. Limerick, Republic of Ireland; Croom Orthopaedic Hospital, Croom, Co. Limerick, Republic of Ireland
| | - Finbarr Condon
- University Hospital Limerick, Dooradoyle, Co. Limerick, Republic of Ireland; Croom Orthopaedic Hospital, Croom, Co. Limerick, Republic of Ireland
| | - Cian Kennedy
- University Hospital Limerick, Dooradoyle, Co. Limerick, Republic of Ireland; Croom Orthopaedic Hospital, Croom, Co. Limerick, Republic of Ireland
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Rothermel LD, Conley CC, Sarode AL, Young MF, Uscanga ZL, McIntyre M, Fleming JB, Vadaparampil ST. Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center. J Natl Compr Canc Netw 2021; 19:1407-1414. [PMID: 34902825 DOI: 10.6004/jnccn.2021.7029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Low health literacy is associated with increased resource use and poorer outcomes in medical and surgical patients with various diseases. This observational study was designed to determine (1) the prevalence of low health literacy among surgical patients with cancer at an NCI-designated Comprehensive Cancer Center (CCC), and (2) associations between health literacy and clinical outcomes. METHODS Patients receiving surgery (N=218) for gastrointestinal (60%) or genitourinary cancers (22%) or sarcomas (18%) were recruited during their postsurgical hospitalization. Patients self-reported health literacy using the Brief Health Literacy Screening Tool (BRIEF). Clinical data (length of stay [LoS], postacute care needs, and unplanned presentation for care within 30 days) were abstracted from the electronic medical records 90 days after surgery. Multivariate linear and logistic regressions were used to examine the relationship between health literacy and clinical outcomes, adjusting for potential confounding variables. RESULTS Of 218 participants, 31 (14%) showed low health literacy (BRIEF score ≤12). In regression analyses including 212 patients with complete data, low health literacy significantly predicted LoS (β = -1.82; 95% CI, -3.00 to -0.66; P=.002) and postacute care needs (odds ratio [OR], 0.25; 95% CI, 0.07-0.91). However, health literacy was not significantly associated with unplanned presentation for care in the 30 days after surgery (OR, 0.51; 95% CI, 0.20-1.29). CONCLUSIONS This study demonstrates the prevalence of low health literacy in a surgical cancer population at a high-volume NCI-designated CCC and its association with important clinical outcomes, including hospital LoS and postacute care needs. Universal screening and patient navigation may be 2 approaches to mitigate the impact of low health literacy on postsurgical outcomes.
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Affiliation(s)
- Luke D Rothermel
- Department of Surgery, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Claire C Conley
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.,Department of Oncology, Georgetown University, Washington, DC
| | - Anuja L Sarode
- University Hospitals Research in Surgical Outcomes and Effectiveness Center, University Hospitals, Cleveland, Ohio
| | - Michael F Young
- Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Zulema L Uscanga
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - McKenzie McIntyre
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Jason B Fleming
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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21
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Holden CE, Wheelwright S, Harle A, Wagland R. The role of health literacy in cancer care: A mixed studies systematic review. PLoS One 2021; 16:e0259815. [PMID: 34767562 PMCID: PMC8589210 DOI: 10.1371/journal.pone.0259815] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients diagnosed with cancer face many challenges and need a good understanding of their diagnosis and proposed treatments to make informed decisions about their care. Health literacy plays an important role in this and low health literacy has been associated with poorer outcomes. The aims of this review are to identify which outcomes relate to health literacy in patients with cancer, and to combine this through a mixed studies approach with the patient experience as described through qualitative studies. METHODS Four electronic databases were searched in January 2021 to identify records relating to health literacy and patients with cancer. Records were independently screened then assessed for inclusion by two reviewers according to the following criteria: patients aged ≥18 years with cancer, English language publication AND health literacy measured with validated tool and measured outcome associated with health literacy OR qualitative study exploring the role of health literacy as patients make decisions about health. Quality was independently assessed by two reviewers. A narrative synthesis was performed, and findings integrated through concept mapping. This systematic review was registered with PROSPERO, entry CRD42020166454. RESULTS 4441 records were retrieved. Following de-duplication, 2496 titles and abstracts were screened and full texts of 405 papers were reviewed for eligibility. 66 papers relating to 60 studies met the eligibility criteria. Lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care. Personal and situational influences contributed to how participants processed information and reached decisions about their care. CONCLUSION This review highlights the important role of health literacy for patients with cancer. Outcomes are poorer for those who experience difficulties with health literacy. Further efforts should be made to facilitate understanding, develop health literacy and support patients to become more involved in their care.
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Affiliation(s)
- Chloe E. Holden
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- Dorset Cancer Centre, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Sally Wheelwright
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Amélie Harle
- Dorset Cancer Centre, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Richard Wagland
- Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
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22
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Theiss LM, Wood T, McLeod MC, Shao C, Santos Marques ID, Bajpai S, Lopez E, Duong AM, Hollis R, Morris MS, Chu DI. The association of health literacy and postoperative complications after colorectal surgery: A cohort study. Am J Surg 2021; 223:1047-1052. [PMID: 34728069 DOI: 10.1016/j.amjsurg.2021.10.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health literacy is a determinant of health. Few studies characterize its association with surgical outcomes. METHODS Retrospective cohort study of patients undergoing elective colorectal surgery 2015-2020. Health literacy assessed using Brief Health Literacy Screening Tool. Outcomes were postoperative complications, LOS, readmissions, mortality. RESULTS Of 552 patients, 46 (8.3%) had limited health literacy, 506 (91.7%) non-limited. Median age 57.7 years, 305 (55.1%) patients were female, 148 (26.8%) were Black. Limited patients had higher rates of overall complications (43.5% vs. 24.3%, p = 0.004), especially surgical site infections (21.7% vs. 11.3%, p = 0.04). Limited patients had longer LOS (5 vs 3.5 days, p = 0.006). Readmissions and mortality did not differ. On multivariable analysis, limited health literacy was independently associated with increased risk of complications (OR 2.03, p = 0.046), not LOS (IRR 1.05, p = 0.67). CONCLUSION Limited health literacy is associated with increased likelihood of complications after colorectal surgery. Opportunities exist for health literate surgical care to improve outcomes for limited health literacy patients.
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Affiliation(s)
- Lauren M Theiss
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Wood
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marshall C McLeod
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Connie Shao
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Swara Bajpai
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Lopez
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anh M Duong
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Hollis
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melanie S Morris
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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van Hoorn BT, van Rossenberg LX, Jacobs X, Sulkers GSI, van Heijl M, Ring D. Clinician Factors Rather Than Patient Factors Affect Discussion of Treatment Options. Clin Orthop Relat Res 2021; 479:1506-1516. [PMID: 33626027 PMCID: PMC8208442 DOI: 10.1097/corr.0000000000001664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shared decision-making aims to combine what matters most to a patient with clinician expertise to develop a personalized health strategy. It is a dialogue between patient and clinician in which preferences are expressed, misconceptions reoriented, and available options are considered. To improve patient involvement, it would help to know more about specific barriers and facilitators of patient-clinician communication. Health literacy, the ability to obtain, process, and understand health information, may affect patient participation in decision-making. If the patient is quiet, deferential, and asks few questions, the clinician may assume a more paternalistic style. A patient with greater agency and engagement could be the catalyst for shared decisions. QUESTIONS/PURPOSES We assessed (1) whether effective clinician communication and effort is related to patient health literacy, and (2) if there are other factors associated with effective clinician communication and effort. METHODS We combined a prospective, cross-sectional cohort of 86 audio-recorded visits of adult patients seeking specialist hand care for a new problem at an urban community hospital in the Netherlands with a cohort of 72 audio-recorded hand surgery visits from a tertiary hospital in the United States collected for a prior study. The American cohort represents a secondary use of data from a set of patients from a separate study using audio-recorded visits and administering similar questionnaires that assessed different endpoints. In both cohorts, adult patients seeking specialist hand care for a new problem were screened. In total, 165 patients were initially screened, of which 96% (158) participated. Eight percent (13) of visits were excluded since the final diagnosis remained unclear, 8% (12) since it was not the first consultation for the current problem, 5% (8) in which only one treatment option was available, and < 1% (1) since there was a language barrier. A total of 123 patients were analyzed, 68 from the Netherlands and 55 from the United States. The Newest Vital Sign (NVS) health literacy test, validated in both English and Dutch, measures the ability to use health information and is based on a nutrition label from an ice cream container. It was used to assess patient health literacy on a scale ranging from 0 (low) to 6 (high). The 5-item Observing Patient Involvement (OPTION5) instrument is commonly used to assess the quality of patient-clinician discussion of options. Scores may be influenced by clinician effort to involve patients in decision-making as well as patient engagement and agency. Each item is scored from 0 (no effort) to 4 (maximum effort), with a total maximum score of 20. Two independent raters reached agreement (kappa value 0.8; strong agreement), after which all recordings were scored by one investigator. Visit duration and patient questions were assessed using the audio recordings. Patients had a median (interquartile range) age of 54 (38 to 66) years, 50% were men, 89% were white, 66% had a nontraumatic diagnosis, median (IRQ) years of education was 16 (12 to 18) years, and median (IQR) health literacy score was 5 (2 to 6). Median (IQR) visit duration was 9 (7 to 12) minutes. Cohorts did not differ in important ways. The number of visits per clinician ranged from 14 to 29, and the mean overall communication effectiveness and effort score for the visits was low (8.5 ± 4.2 points of 20 points). A multivariate linear regression model was used to assess factors associated with communication effectiveness and effort. RESULTS There was no correlation between health literacy and clinician communication effectiveness and effort (r = 0.087 [95% CI -0.09 to 0.26]; p = 0.34), nor was there a difference in means (SD) when categorizing health literacy as inadequate (7.8 ± 3.8 points) and adequate (8.9 ± 4.5 points; mean difference 1.0 [95% CI -2.6 to 0.54]; p = 0.20). After controlling for potential confounding variables such as gender, patient questions, and health literacy, we found that longer visit duration (per 1 minute increase: r2 = 0.31 [95% CI -0.14 to 0.48]; p < 0.001), clinician 3 (compared with clinician 1: OR 33 [95% CI 4.8 to 229]; p < 0.001) and clinician 5 (compared with clinician 1: OR 11 [95% CI 1.5 to 80]; p = < 0.02) were independently associated with more effective communication and effort, whereas clinician 6 was associated with less effective communication and effort (compared with clinician 1: OR 0.08 [95% CI 0.01 to 0.75]; p = 0.03). Clinicians' communication strategies (the clinician variable on its own) accounted for 29% of the variation in communication effectiveness and effort, longer visit duration accounted for 11%, and the full model accounted for 47% of the variation (p < 0.001). CONCLUSION The finding that the overall low mean communication effectiveness and effort differed between clinicians and was not influenced by patient factors including health literacy suggests clinicians may benefit from training that moves them away from a teaching or lecturing style where patients receive rote directives regarding their health. Clinicians can learn to adapt their communication to specific patient values and needs using a guiding rather than directing communication style (motivational interviewing).Level of Evidence Level II, prognostic study.
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Affiliation(s)
- Bastiaan T. van Hoorn
- Department of Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - Luke X. van Rossenberg
- Department of Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - Xander Jacobs
- Department of Plastic Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - George S. I. Sulkers
- Department of Plastic Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand Service, Diakonessenhuis, Medical University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Hamdan S, Kripalani S, Geiger TM, Dennis BM, Ford MM, Zhao Z, Ye F, Hawkins AT. Far from black and white: Role of race, health literacy, and socioeconomic factors in the presentation of acute diverticulitis. Surgery 2021; 170:1637-1643. [PMID: 34183181 DOI: 10.1016/j.surg.2021.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Racial discrepancies in treatment and outcomes of acute diverticulitis have been observed, yet underlying factors are poorly understood. We aimed to identify racial inequalities in health literacy among patients hospitalized with acute diverticulitis and characterize factors associated with more severe presentation. METHODS We performed retrospective cohort analysis of 947 Black or White patients admitted with acute diverticulitis at a quaternary referral center from January 2009 through September 2019. Health literacy was determined by the validated Brief Health Literacy Screening, and socioeconomic status was defined by area deprivation index, a composite of multiple neighborhood socioeconomic deprivation measures. The primary outcome was severity of disease presentation represented by systemic inflammatory response syndrome criteria; secondary outcomes included intensive care unit admission, length of stay, and invasive interventions. RESULTS Among all study participants, 121 (12.8%) self-identified as Black. Overall, 140 (14.8%) patients had inadequate health literacy, and 495 (52.3%) had area deprivation index greater than the national median. There was no association between race or area deprivation index and health literacy. A total of 340 (35.9%) patients met criteria for systemic inflammatory response syndrome, and 88 (9.3%) underwent an intervention; median length of stay was 3.5 days. Race, health literacy, and area deprivation index were not significantly associated with outcomes (P > .05). CONCLUSION Among patients with acute diverticulitis, no difference in severity of presentation by race, health literacy, or area deprivation index was observed. These findings suggest that differences in presentation of acute diverticulitis may not be driven by these social factors. Future studies should include considerations of clinical characteristics of acute diverticulitis, such as the role of access and underuse of healthcare resources.
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Affiliation(s)
- Saif Hamdan
- Vanderbilt University School of Medicine, Nashville, TN
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Timothy M Geiger
- Department of Surgery, Division of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Bradley M Dennis
- Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Molly M Ford
- Department of Surgery, Division of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander T Hawkins
- Department of Surgery, Division of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN.
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Ó Doinn T, Broderick JM, Abdelhalim MM, Quinlan JF. Readability of Patient Educational Materials in Pediatric Orthopaedics. J Bone Joint Surg Am 2021; 103:e47. [PMID: 33543881 DOI: 10.2106/jbjs.20.01347] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Parents are increasingly turning to the internet to seek pediatric health information. Numerous organizations advise that patient educational materials (PEMs) should not surpass the sixth-grade reading level. We aimed to assess the readability of online pediatric orthopaedic PEMs. METHODS The readability of 176 articles pertaining to pediatric orthopaedics from the American Academy of Orthopaedic Surgeons (AAOS), Pediatric Orthopaedic Society of North America (POSNA), and American Academy of Pediatrics (AAP) websites was assessed with the use of 8 readability formulae: the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Raygor Estimate, the SMOG, the Coleman-Liau, the Fry, the FORCAST, and the Gunning Fog. The mean reading grade level (RGL) of each article was compared with the sixth and eighth-grade reading levels. The mean RGL of each website's articles also was compared. RESULTS The cumulative mean RGL was 10.2 (range, 6.6 to 16.0). No articles (0%) were written at the sixth-grade reading level, and only 7 articles (4.0%) were written at or below the eighth-grade reading level. The mean RGL was significantly higher than the sixth-grade (95% confidence interval [CI] for the difference, 4.0 to 4.4; p < 0.001) and eighth-grade (95% CI, 2.0 to 2.4; p < 0.001) reading levels. The mean RGL of articles on the POSNA website was significantly lower than the mean RGL of the articles on the AAOS (95% CI, -1.8 to -1.0; p < 0.001) and AAP (95% CI, -2.9 to -1.1; p < 0.001) websites. CONCLUSIONS Pediatric orthopaedic PEMs that are produced by the AAOS, the POSNA, and the AAP have readability scores that exceed recommendations. Given the increasing preference of parents and adolescents for online health information, the growing body of online PEMs, and the critical role that health literacy plays in patient outcomes, substantial work is required to address the readability of these materials.
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Affiliation(s)
- Tiarnán Ó Doinn
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
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26
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Richards HL, Sweeney P, Corscadden R, Carr C, Rukundo A, Fitzgerald J, O'Connor C, Fortune DG. "Picture this"- Patients' Drawings of Non-Muscle Invasive Bladder Cancer: A Novel Method to Help Understand How Patients Perceive Their Condition. Bladder Cancer 2021; 7:149-159. [PMID: 38994531 PMCID: PMC11181761 DOI: 10.3233/blc-201528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of data regarding patient experiences of living with non-muscle-invasive bladder cancer (NMIBC). OBJECTIVES To investigate patients' beliefs about NMIBC utilising both a well-established verbal/linguistic method, the Brief Illness Perception Questionnaire (B-IPQ) in addition to a novel visual/perceptual method, that is, asking patients to draw their bladder as it is now and as they perceive it will be in the future. METHODS Cross-sectional study of patients with NMIBC. Patients completed: (i) the B-IPQ, and (ii) 2 drawings of their bladder: as they perceived it currently and as they perceived it would look in 5 years' time. RESULTS A total of 118 patients completed the B-IPQ, of which 96 produced 2 bladder drawings. Forty-seven per cent of patients depicted no change in their bladder across time, 35% depicted improvements, while 18% drew their NMIBC as deteriorating between the two time points. Patients who drew their NMIBC worsening over time reported significantly stronger beliefs in the severity of current consequences from their NMIBC (F(2,94) = 9.07, p < 0.001, m = 5.68, 95% CI 4.38-6.88) and greater current concerns about their NMIBC (F(2,94) = 6.17, p < 0.01, m = 7.06, 95% CI 5.47-8.66). This was unrelated to cancer grade, cancer stage, treatment or demographic variables. CONCLUSION This is the first study to explore beliefs about NMIBC in a sample of patients with NMIBC attending routine clinics using both a well-established and a novel method of assessing patients' perceptions. Results highlight the usefulness of a simple non-verbal technique, in identifying patients' concerns about the condition. Almost one fifth of patients with NMIBC may experience significant concerns about the worsening of their condition, which appear to be independent of demographic, histopathological, and treatment related variables. Further exploration of the psychological concerns of individuals with NMIBC is required in order to appropriately plan for needs led multidisciplinary approach in their care.
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Affiliation(s)
- Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Paul Sweeney
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Rebekah Corscadden
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Chelsea Carr
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Aphie Rukundo
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Jill Fitzgerald
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Charles O'Connor
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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27
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Catto JWF, Downing A, Mason S, Wright P, Absolom K, Bottomley S, Hounsome L, Hussain S, Varughese M, Raw C, Kelly P, Glaser AW. Quality of Life After Bladder Cancer: A Cross-sectional Survey of Patient-reported Outcomes. Eur Urol 2021; 79:621-632. [PMID: 33581875 PMCID: PMC8082273 DOI: 10.1016/j.eururo.2021.01.032] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about health-related quality of life (HRQOL) following treatment for bladder cancer (BC). OBJECTIVE To determine this, we undertook a cross-sectional survey covering 10% of the English population. DESIGN, SETTING, AND PARTICIPANTS Participants 1-10 yr from diagnosis were identified through national cancer registration data. INTERVENTION A postal survey was administered containing generic HRQOL and BC-specific outcome measures. Findings were compared with those of the general population and other pelvic cancer patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Generic HRQOL was measured using five-level EQ-5D (EQ-5D-5L) and European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ)-C30. BC-specific outcomes were derived from EORTC QLQ-BLM30 and EORTC QLQ-NMIBC24. RESULTS AND LIMITATIONS A total of 1796 surveys were completed (response rate 55%), including 868 (48%) patients with non-muscle-invasive BC, 893 (50%) patients who received radiotherapy or radical cystectomy, and 35 (1.9%) patients for whom treatment was unknown. Most (69%) of the participants reported at least one problem in any EQ-5D dimension. Age/sex-adjusted generic HRQOL outcomes were similar across all stages and treatment groups, whilst problems increased with age (problems in one or more EQ-5D dimensions: <65 yr [67% {95% confidence interval or CI: 61-74}] vs 85+ yr [84% {95% CI: 81-89}], p = 0.016) and long-term conditions (no conditions [53% {95% CI: 48-58}] vs more than four conditions [94% {95% CI: 90-97}], p < 0.001). Sexual problems were reported commonly in men, increasing with younger age and radical treatment. Younger participants (under 65 yr) reported more financial difficulties (mean score 20 [95% CI: 16-25]) than those aged 85+ yr (6.8 [4.5-9.2], p < 0.001). HRQOL for BC patients (for comparison, males with problems in one or more EQ-5D dimensions 69% [95% CI: 66-72]) was significantly worse than what has been found after colorectal and prostate cancers and in the general population (51% [95% CI: 48-53], all p < 0.05). CONCLUSIONS HRQOL following BC appears to be relatively independent of disease stage, treatment, and multimodal care. Issues are reported with sexual function and financial toxicity. HRQOL after BC is worse than that after other pelvic cancers. PATIENT SUMMARY Patients living with bladder cancer often have reduced quality of life, which may be worse than that for other common pelvic cancer patients. Age and other illnesses appear to be more important in determining this quality of life than the treatments received. Many men complain of sexual problems. Younger patients have financial worries.
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Affiliation(s)
- James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
| | - Amy Downing
- Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Samantha Mason
- Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Sarah Bottomley
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Syed Hussain
- Academic Oncology Unit, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - Mohini Varughese
- Beacon Oncology Centre, Musgrove Park Hospital, Taunton and Somerset Foundation Trust, Somerset, UK
| | | | | | - Adam W Glaser
- Leeds Institute of Medical Research at St James's and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Broderick JM, McCarthy A, Hogan N. Osteotomy around the knee: Assessment of quality, content and readability of online information. Knee 2021; 28:139-150. [PMID: 33360380 DOI: 10.1016/j.knee.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND As knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee. METHODS The first 70 websites returned by the top four search engines were identified using the key words: "knee osteotomy" and "high tibial osteotomy." The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared. RESULTS Of the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as 'poor.' The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores. The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as 'difficult.' Journal websites had the highest RGL. CONCLUSION The information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood. LEVEL OF EVIDENCE Survey of materials - Internet.
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Affiliation(s)
- James M Broderick
- Department of Trauma & Orthopaedics, St. James's Hospital, James's Street, Dublin D08 NHY1, Ireland.
| | - Andrea McCarthy
- Department of Trauma & Orthopaedics, St. James's Hospital, James's Street, Dublin D08 NHY1, Ireland
| | - Niall Hogan
- Department of Trauma & Orthopaedics, St. James's Hospital, James's Street, Dublin D08 NHY1, Ireland
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Chang ME, Baker SJ, Dos Santos Marques IC, Liwo AN, Chung SK, Richman JS, Knight SJ, Fouad MN, Gakumo CA, Davis TC, Chu DI. Health Literacy in Surgery. Health Lit Res Pract 2020; 4:e46-e65. [PMID: 32053207 PMCID: PMC7015264 DOI: 10.3928/24748307-20191121-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%–50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45–e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel I. Chu
- Address correspondence to Daniel I. Chu, MD, Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 428, 1720 2nd Avenue S., Birmingham, AL 35294-0016;
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30
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Doinn TÓ, Broderick JM, Abdelhalim MM, Quinlan JF. Readability of Patient Educational Materials in Hip and Knee Arthroplasty: Has a Decade Made a Difference? J Arthroplasty 2020; 35:3076-3083. [PMID: 32631729 DOI: 10.1016/j.arth.2020.05.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Internet has become an increasingly popular resource among orthopedic patients for health education. Numerous organisations recommend that patient educational materials (PEMs) should not exceed the 6th grade reading level. Despite this, studies have repeatedly shown the reading grade level (RGL) of PEMs to be too advanced across a range of surgical specialties. We aimed to determine the readability of online hip and knee arthroplasty PEMs. METHODS The readability of 134 articles pertaining to hip and knee arthroplasty from 5leading worldwide healthcare websites were assessed, using 8 readability formulae; the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST and Gunning Fog. The mean RGL was compared to the 6th and 8thgrade reading level. The mean RGL of each website was also compared. RESULTS The mean cumulative RGL was 12 (range = 7-16.1). No articles (0%) were written at a 6th grade reading level and only 4 articles (3%) were written at or below the 8th grade reading level. The mean RGL was significantly higher than the 6th (95% CI, 5.62-6.30; P < .0001) and 8th grade reading level (95% CI, 3.63-4.30; P < .0001). There was a significant difference between the RGLs of the 5websites (P = .001). CONCLUSION Arthroplasty PEMs produced by leading worldwide healthcare organisations have readability scores that are above the recommended levels. Given the imperative role of health literacy in patient outcomes and satisfaction, and the increasing prevalence of Internet use among orthopedic patients, a substantial amount of work needs to be done to improve the readability of these materials.
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Affiliation(s)
- Tiarnán Ó Doinn
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - James M Broderick
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Muthana M Abdelhalim
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - John F Quinlan
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
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Haider S, Wood K, Bui A, Leitman IM. Racial Disparities in Outcomes After Common Abdominal Surgical Procedures-The Impact of Access to a Minimally Invasive Approach. J Surg Res 2020; 257:85-91. [PMID: 32818788 DOI: 10.1016/j.jss.2020.07.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is presently considered the standard of care to perform many routine intra-abdominal operations using a minimally invasive approach. The authors recently identified a racial disparity in access to a laparoscopic approach to inguinal hernia repair, cholecystectomy, appendectomy, and colectomy. The present study further evaluates this patient cohort to assess the relationship between the race and postoperative complications and test the mediating effect of the selected surgical approach. METHODS After institutional review board approval, patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent inguinal hernia repair, cholecystectomy, appendectomy, or colectomy in 2016 were identified. Patient demographics, including the self-reported race and ethnicity, as well as clinical, operative, and postoperative variables were recorded. After the exclusion of cases associated with diagnoses of cancer, a 4:1 propensity score matching algorithm generated a clinically balanced cohort of patients of white and black self-reported race. The mediating effect of an open approach to surgery on the relationship between black self-reported race and postoperative complications was evaluated via a series of regressions. RESULTS There were 41,340 unilateral inguinal hernia repairs, 3182 bilateral inguinal hernia repairs, 60,444 cholecystectomies, 50,523 appendectomies, and 58,012 colectomies included in the database in 2017. Exclusion of cases associated with cancer and subsequent propensity score matching returned 17,540 unilateral hernia repairs, 890 bilateral hernia repairs, 23,865 cholecystectomies, 11,660 appendectomies, and 12,320 colectomies. On mediation analysis, any complication, severe complication, and death were significant when regressed on black self-reported race (any: odds ratio [OR] = 1.210, 95% confidence interval [CI] = 1.132-1.291, P < 0.001; severe: OR = 1.352, 95% CI = 1.245-1.466, P < 0.001; death: OR = 1.358, 95% CI = 1.000-1.818, P = 0.044), and open surgery was a significant mediator in the incidence of any complication and severe complication (any: OR = 1.180, 95% CI = 1.105-1.260, P < 0.001 and severe: OR = 1.307, 95% CI = 1.203-1.418, P < 0.001). CONCLUSIONS These findings underscore the importance of access to a minimally invasive approach to surgery. However, other factors may contribute to racial disparities in postoperative complications after common abdominal operations.
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Affiliation(s)
- Syed Haider
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kasey Wood
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anthony Bui
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
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Baker S, Malone E, Graham L, Dasinger E, Wahl T, Titan A, Richman J, Copeland L, Burns E, Whittle J, Hawn M, Morris M. Patient-reported health literacy scores are associated with readmissions following surgery. Am J Surg 2020; 220:1138-1144. [PMID: 32682501 DOI: 10.1016/j.amjsurg.2020.06.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/05/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health literacy (HL) impacts medical care. We hypothesized that patients with low HL would have higher readmission rates following surgery. METHODS We conducted a prospective, multi-institutional study from 8/2015-6/2017 within the Veterans Affairs (VA) System including veterans who underwent general, vascular, or thoracic surgery. HL was assessed by Brief Health Literacy Screener and stratified into adequate vs. low. Patients were followed for 30 days post-discharge. Multivariable analyses examined correlations and logistic regression models adjusted for covariates. RESULTS 736 patients were enrolled in the study; 98% (n = 722) completed the HL survey. At discharge, 33.2% of patients had low HL. The overall 30-day readmission rate was 16.3%, with a significant difference by HL (Adequate HL: 13.3% vs. Low HL: 22.5%, p < 0.01). After adjusting for clinical and demographic covariates, patients with low HL were 59% more likely to be readmitted (OR = 1.59, 95% CI = 1.02-2.50). CONCLUSION Low HL is common among VA surgery patients and is associated with readmission. Future studies should be focused on interventions to target this vulnerable patient population.
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Affiliation(s)
- Samantha Baker
- University of Alabama at Birmingham, Birmingham, AL, USA; VA Birmingham Healthcare System, Birmingham, AL, USA.
| | - Emily Malone
- University of Alabama at Birmingham, Birmingham, AL, USA; VA Birmingham Healthcare System, Birmingham, AL, USA
| | - Laura Graham
- VA Palo Alto Healthcare Systems, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA
| | - Elise Dasinger
- University of Alabama at Birmingham, Birmingham, AL, USA; VA Birmingham Healthcare System, Birmingham, AL, USA
| | - Tyler Wahl
- University of Alabama at Birmingham, Birmingham, AL, USA; VA Birmingham Healthcare System, Birmingham, AL, USA
| | - Ashley Titan
- VA Palo Alto Healthcare Systems, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA
| | - Joshua Richman
- University of Alabama at Birmingham, Birmingham, AL, USA; VA Birmingham Healthcare System, Birmingham, AL, USA
| | - Laurel Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Edith Burns
- Milwaukee VA Medical Center, Milwaukee, WI, USA
| | | | - Mary Hawn
- VA Palo Alto Healthcare Systems, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA
| | - Melanie Morris
- University of Alabama at Birmingham, Birmingham, AL, USA; VA Birmingham Healthcare System, Birmingham, AL, USA
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Theiss LM, Chu DI. Invited commentary on "Delving deeper into disparity: The impact of health literacy on the surgical care of breast cancer patients". Am J Surg 2020; 220:804-805. [PMID: 32563518 DOI: 10.1016/j.amjsurg.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Lauren M Theiss
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA.
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Nakata H, Halbach S, Geiser F, Stock S, Kowalski C, Enders A, Pfaff H, Ernstmann N. Health literacy, mental disorders and fear of progression and their association with a need for psycho-oncological care over the course of a breast cancer treatment. PSYCHOL HEALTH MED 2020; 26:818-831. [PMID: 32484756 DOI: 10.1080/13548506.2020.1772987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psycho-oncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.
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Affiliation(s)
- Hannah Nakata
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | | | - Anna Enders
- Department for Health Promotion for Vulnerable Groups, The Federal Centre for Health Education (BZgA), Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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35
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Portelli Tremont JN, Downs-Canner S, Maduekwe U. Delving deeper into disparity: The impact of health literacy on the surgical care of breast cancer patients. Am J Surg 2020; 220:806-810. [PMID: 32444064 DOI: 10.1016/j.amjsurg.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast surgical oncology is a unique field that involves complex cancer management and longstanding patient interactions with the healthcare system, making it potentially challenging for patients with low health literacy. The purpose of this review is to summarize the current knowledge regarding health literacy in breast cancer and identify future directions for research and potential intervention in breast surgical oncology. DATA SOURCES A search of relevant literature querying PubMed and Science Direct was performed and included the following keywords: health literacy, breast cancer, breast surgical oncology, surgery, outcomes, prevention, screening, healthcare utilization, chronic disease. CONCLUSIONS Limited health literacy may detrimentally affect understanding and outcomes in breast surgical oncology. Identifying ways providers can improve patient understanding and utilization of health information is important, and surgeons may have a pivotal role. Further studies addressing health literacy in breast surgical oncology is needed in order to better optimize care of patients.
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Affiliation(s)
- Jaclyn N Portelli Tremont
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| | - Stephanie Downs-Canner
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| | - Ugwuji Maduekwe
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
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Cohen TN, Cohen KA, Burton CS, Kanji FF, Francis SE, Patel DC, Ackerman AL, Eilber KS, Anger JT. Identifying Opportunities to Improve Patient Experience With Sacral Neuromodulation: A Human Factors Approach. Urology 2020; 150:207-212. [PMID: 32389820 DOI: 10.1016/j.urology.2020.04.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/31/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To use a human factors approach to conduct a needs assessment of patient preparedness, education, device usability, and satisfaction regarding all stages of sacral neuromodulation therapy and identify opportunities for improvement. Sacral neuromodulation, though minimally invasive, involves an initial testing phase that requires active patient participation. This process is relatively complex and, if a patient does not receive adequate preprocedure education, can be difficult to conceptualize. MATERIALS AND METHODS Candidates were recruited to participate before undergoing staged sacral neuromodulation. Ten patients were observed, and their experiences were evaluated at 4 phases: (1) date of test implant (Stage I), (2) 5 days following Stage I, (3) date of permanent implant (Stage II), and (4) 3 months following Stage II. Administered questionnaires focused on preoperative preparedness, postoperative satisfaction, and usability. RESULTS While every patient reported that their symptoms were at least "a little better" postoperatively, they generally had difficulty understanding the risks of the planned procedure, did not know what to expect postoperatively and were unsatisfied with the preoperative materials. Patients struggled with adjusting the settings for their implant devices and usability was considered "below average." Despite overall objective success, 30% of patients indicated that they would not recommend this treatment to friends/family. CONCLUSION This pilot needs analysis demonstrates several opportunities for improvement in the experience of patients undergoing sacral neuromodulation. These findings highlight the opportunities for a multifaceted intervention to improve patient understanding through the testing phase.
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Affiliation(s)
- Tara N Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA.
| | - Kate A Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA
| | - Claire S Burton
- University of California Los Angeles, Department of Urology, Los Angeles, CA
| | - Falisha F Kanji
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA
| | - Sarah E Francis
- Cedars-Sinai Medical Center, Department of Perioperative Services, Los Angeles, CA
| | - Deven C Patel
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA
| | | | - Karyn S Eilber
- Cedars-Sinai Health System, Department of Surgery, Division of Urology, Los Angeles, CA
| | - Jennifer T Anger
- Cedars-Sinai Health System, Department of Surgery, Division of Urology, Los Angeles, CA
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Mc Carthy A, Taylor C. SUFE and the internet: are healthcare information websites accessible to parents? BMJ Paediatr Open 2020; 4:e000782. [PMID: 33094174 PMCID: PMC7577056 DOI: 10.1136/bmjpo-2020-000782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/28/2020] [Accepted: 09/06/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Slipped upper femoral epiphysis is an adolescent hip disorder requiring rapid surgical intervention. Faced with the prospect of their child undergoing surgery, many fearful parents will turn to the internet to provide information and reassurance. Previous studies have shown the orthopaedic information can be difficult to comprehend. OBJECTIVE Assess the readability of healthcare websites regarding slipped upper femoral epiphysis. METHODS The term Slipped Upper Femoral Epiphysis was searched in Google, Bing and Yahoo. The websites were evaluated using readability software with seven specialised readability tests including the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index and the Gunning Fog Index. The reading grade level (RGL) was also calculated.A Flesich Read Ease Score (FRES) score above 65 and an RGL of sixth grade and under was considered acceptable. Websites were also assessed for translation services. RESULTS 21 unique websites were assessed. The average FRES was 52.5±15.4. Only 3 websites scored 65 or higher (14%). There was a statistically significant difference between website scores based on affiliation, with physician websites having the overall highest mean(p=0.004).The average RGL was 8.67±1.8. Only two websites met the accepted RGL criteria (9.5%) while five websites were marked as extremely difficult to understand (23.8%). Only five websites offered translations (23.8%). There was no statistically significant difference in readability scores between websites which offered translation and those which did not.One-sample t-tests showed that both the RGL (p<0.001; CI 1.83 to 3.49) and the FRES (p<0.001, CI -19.4 to -5.4) scores were significantly different from the accepted standard. CONCLUSION Most websites reviewed were above the recommended RGL, making content inaccessible. Improving readability and translation services would enhance the internet's usability as a healthcare tool for parents.
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Affiliation(s)
- Andrea Mc Carthy
- Orthopaedic Department, Cork University Hospital Group, Cork, Ireland
| | - Colm Taylor
- Orthopaedic Department, Cork University Hospital Group, Cork, Ireland
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Hadden KB, Kripalani S. Health Literacy 2.0: Integrating Patient Health Literacy Screening with Universal Precautions. Health Lit Res Pract 2019; 3:e280-e285. [PMID: 31893260 PMCID: PMC6901362 DOI: 10.3928/24748307-20191028-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kristie B. Hadden
- Address correspondence to Kristie B. Hadden, PhD, Center for Health Literacy, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #599A, Little Rock, AR 72205-7199;
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Luckenbaugh AN, Moses KA. The impact of health literacy on urologic oncology care. Urol Oncol 2019; 40:117-119. [PMID: 31324457 PMCID: PMC10182894 DOI: 10.1016/j.urolonc.2019.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/29/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
Health literacy is the ability to access, comprehend, and act upon medical information to make health care decisions. In the United States, 12% of adults have proficient health literacy. Low health literacy has been associated with worse outcomes in several chronic medical conditions. In addition, low health literacy has been associated with longer hospital stays. In the urologic oncology literature low health literacy is associated with increased minor complications following radical cystectomy. There remains sparse data on health literacy and its impacts on prostate, kidney, testicular and penile cancer care. Going forward, in order to provide the best urologic oncology care to our patients it is critical to account for patients' health literacy status.
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Affiliation(s)
- Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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40
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Universal Measures of Support Are Needed: A Cross-Sectional Study of Health Literacy in Patients with Dupuytren's Disease. Plast Reconstr Surg 2019; 143:350e-358e. [PMID: 30688895 DOI: 10.1097/prs.0000000000005209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Health literacy represents the degree to which patients can understand and act on health information. The relevance of health literacy to health care delivery, outcomes, and overall surgical care is unambiguous. This study aimed (1) to determine the prevalence of limited health literacy in patients diagnosed with Dupuytren's contracture and (2) to identify independent predictors of limited health literacy. METHODS This cross-sectional study included patients with Dupuytren's disease and with self-reported English fluency. The Newest Vital Sign, a rapid, validated, and reliable screening tool, was selected to measure health literacy. An exploratory multivariable logistic regression model was used to identify possible predictors of limited health literacy. RESULTS A total of 185 patients met eligibility criteria and were included. From those, 82 (44 percent) were found to have limited health literacy, defined as a score of 3 or less on the Newest Vital Sign. The domain of prose literacy was most highly scored compared to numeracy and document literacy. Lower household income was associated with a 4.7-fold increase in the odds of having limited health literacy. Being an immigrant also increased the odds of having limited health literacy by a factor of 3.6. Sensitivity analyses and subgroup analyses (based on education, maternal language, and immigration status) corroborated these independent predictor findings. CONCLUSIONS Limited health literacy is common among patients with Dupuytren's contracture. System level changes are necessary such as the access and integration to clinical care of universal measures of support to promote productive patient-surgeon interactions.
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Neter E, Brainin E. Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000350] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly ( n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search ( n = 26); (3) articles on eHealth literacy and its association with health outcomes ( n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
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Sosland R, Kowalik CA, Cohn JA, Milam DF, Kaufman MR, Dmochowski RR, Reynolds WS. Nonclinical Barriers to Care for Neurogenic Patients Undergoing Complex Urologic Reconstruction. Urology 2018; 124:271-275. [PMID: 30366042 DOI: 10.1016/j.urology.2018.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify nonclinical factors affecting postoperative complication rates in patients with neurogenic bladder undergoing benign genitourinary (GU) reconstruction. METHODS Adult patients with neurogenic bladder undergoing benign GU reconstruction between October 2010 and November 2015 were included. Patients were excluded if a diversion was performed for malignancy, if patients had a history of radiation or if a new bowel segment was not utilized at the time of the operation. Clinical and nonclinical factors were abstracted from the patients' electronic medical records. Health literacy was assessed via the Brief Health Literacy Screen (BHLS), a validated 3-question assessment. Education, marital status, and distance from the medical center were also queried. RESULTS Forty-nine patients with a neurogenic bladder undergoing complex GU reconstruction met inclusion and exclusion criteria. On average, patients lived 111 miles (standard deviation 89) from the hospital. Overall, mean BHLS score was 10.4 (standard deviation 4.6) with 35% of patients scoring a BHLS of ≤9. Mean years of educational attainment was 9.7, and only 31% of patients completed high school education. In the first month after surgery, 37 patients (76%) experienced a complication, and 22% were readmitted; however, analysis of complication data did not identify an association between any nonclinical variables and complication rates. CONCLUSION Nonclinical factors including unmarried status, poor health literacy, and marked distance from quaternary care are prevalent in patients with neurogenic bladder undergoing complex GU reconstruction. To mitigate these potential risk factors, the authors recommend acknowledgment of these factors and multidisciplinary support perioperatively to counteract them.
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Affiliation(s)
| | | | - Josh A Cohn
- Vanderbilt University Medical Center, Nashville, TN
| | - Doug F Milam
- Vanderbilt University Medical Center, Nashville, TN
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Papadakos JK, Hasan SM, Barnsley J, Berta W, Fazelzad R, Papadakos CJ, Giuliani ME, Howell D. Health literacy and cancer self-management behaviors: A scoping review. Cancer 2018; 124:4202-4210. [DOI: 10.1002/cncr.31733] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Janet K. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Salwa M. Hasan
- Undergraduate Medical Education, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Jan Barnsley
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Rouhi Fazelzad
- Library and Information Services; Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Christine J. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Meredith E. Giuliani
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Radiation Medicine Program; Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Radiation Oncology, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Doris Howell
- Division of Psychosocial Oncology and Palliative Care; Ontario Cancer Institute; Princess Margaret Cancer Centre Toronto Ontario Canada
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Staging the Host: Personalizing Risk Assessment for Radical Cystectomy Patients. Eur Urol Oncol 2018; 1:292-304. [DOI: 10.1016/j.euo.2018.05.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/12/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
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Roy M, Corkum JP, Urbach DR, Novak CB, von Schroeder HP, McCabe SJ, Okrainec K. Health Literacy Among Surgical Patients: A Systematic Review and Meta-analysis. World J Surg 2018; 43:96-106. [DOI: 10.1007/s00268-018-4754-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Wright JP, Moses K, Idrees K. Making the Case for Importance of Health Literacy in the Surgical Population. JAMA Surg 2018; 153:745-746. [PMID: 29710089 DOI: 10.1001/jamasurg.2018.0673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jesse P Wright
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelvin Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Wright JP, Edwards GC, Goggins K, Tiwari V, Maiga A, Moses K, Kripalani S, Idrees K. Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. JAMA Surg 2018; 153:137-142. [PMID: 28979989 PMCID: PMC5838587 DOI: 10.1001/jamasurg.2017.3832] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Low health literacy is known to adversely affect health outcomes in patients with chronic medical conditions. To our knowledge, the association of health literacy with postoperative outcomes has not been studied in-depth in a surgical patient population. Objective To evaluate the association of health literacy with postoperative outcomes in patients undergoing major abdominal surgery. Design, Setting, and Participants From November 2010 to December 2013, 1239 patients who were undergoing elective gastric, colorectal, hepatic, and pancreatic resections for both benign and malignant disease at a single academic institution were retrospectively reviewed. Patient demographics, education, insurance status, procedure type, American Society of Anesthesiologists status, Charlson comorbidity index, and postoperative outcomes, including length of stay, emergency department visits, and hospital readmissions, were reviewed from electronic medical records. Health literacy levels were assessed using the Brief Health Literacy Screen, a validated tool that was administered by nursing staff members on hospital admission. Multivariate analysis was used to determine the association of health literacy levels on postoperative outcomes, controlling for patient demographics and clinical characteristics. Main Outcomes and Measures The association of health literacy with postoperative 30-day emergency department visits, 90-day hospital readmissions, and index hospitalization length of stay. Results Of the 1239 patients who participated in this study, 624 (50.4%) were women, 1083 (87.4%) where white, 96 (7.7%) were black, and 60 (4.8%) were of other race/ethnicity. The mean (SD) Brief Health Literacy Screen score was 12.9 (SD, 2.75; range, 3-15) and the median educational attainment was 13.0 years. Patients with lower health literacy levels had a longer length of stay in unadjusted (95% CI, 0.95-0.99; P = .004) and adjusted (95% CI, 0.03-0.26; P = .02) analyses. However, lower health literacy was not significantly associated with increased rates of 30-day emergency department visits or 90-day hospital readmissions. Conclusions and Relevance Lower health literacy levels are independently associated with longer index hospitalization lengths of stay for patients who are undergoing major abdominal surgery. The role of health literacy needs to be further evaluated within surgical practices to improve health care outcomes and use.
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Affiliation(s)
- Jesse P. Wright
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gretchen C. Edwards
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Goggins
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vikram Tiwari
- Department Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amelia Maiga
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelvin Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Christy SM, Gwede CK, Sutton SK, Chavarria E, Davis SN, Abdulla R, Ravindra C, Schultz I, Roetzheim R, Meade CD. Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs. JOURNAL OF HEALTH COMMUNICATION 2017; 22:923-931. [PMID: 29125435 PMCID: PMC6278594 DOI: 10.1080/10810730.2017.1377322] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.
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Affiliation(s)
- Shannon M. Christy
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Clement K. Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Steven K. Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Enmanuel Chavarria
- University of Texas Health Science Center at Houston, School of Public Health, Department of Health Promotion and Behavioral Sciences, Brownsville, Texas, USA
| | - Stacy N. Davis
- Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Chitra Ravindra
- Florida Department of Health Pinellas County, St. Petersburg, Florida, USA
| | - Ida Schultz
- Premier Community HealthCare Group, Inc., Dade City, Florida, USA
| | - Richard Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Cathy D. Meade
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Boyle J, Speroff T, Worley K, Cao A, Goggins K, Dittus RS, Kripalani S. Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients. J Hosp Med 2017; 12:918-924. [PMID: 29091980 DOI: 10.12788/jhm.2841] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the association of health literacy with the number and type of transitional care needs (TCN) among patients being discharged to home. DESIGN, SETTING, PARTICIPANTS A cross-sectional analysis of patients admitted to an academic medical center. MEASUREMENTS Nurses administered the Brief Health Literacy Screen and documented TCNs along 10 domains: caregiver support, transportation, healthcare utilization, high-risk medical comorbidities, medication management, medical devices, functional status, mental health comorbidities, communication, and financial resources. RESULTS Among the 384 patients analyzed, 113 (29%) had inadequate health literacy. Patients with inadequate health literacy had needs in more TCN domains (mean = 5.29 vs 4.36; P < 0 .001). In unadjusted analysis, patients with inadequate health literacy were significantly more likely to have TCNs in 7 out of the 10 domains. In multivariate analyses, inadequate health literacy remained significantly associated with inadequate caregiver support (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.37-4.99) and transportation barriers (OR, 1.69; 95% CI, 1.04-2.76). CONCLUSIONS Among hospitalized patients, inadequate health literacy is prevalent and independently associated with other needs that place patients at a higher risk of adverse outcomes, such as hospital readmission. Screening for inadequate health literacy and associated needs may enable hospitals to address these barriers and improve postdischarge outcomes.
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Affiliation(s)
- Joseph Boyle
- School of Graduate Medical Education, University of Colorado, Aurora, Colorado, USA
| | - Theodore Speroff
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine Worley
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aize Cao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Dittus
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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