Health Literacy and Change in Health-Related Quality of Life in Dialysed Patients

Health-related quality of life (HRQoL) is likely to deteriorate with the progression of chronic kidney disease (CKD). This change may be worsened by low health literacy (HL). We performed a longitudinal study at over 20 dialysis clinics in Slovakia (n = 413; mean age = 64.8 years; males = 58.4%). We assessed the association of three HL groups with a change in HRQoL over two years using binary logistic regression adjusted for type of vascular access, dialysis effectiveness, comorbidity, age and gender. We found that patients with low HL had poorer HRQoL at baseline in comparison to high-HL patients. We did not find significant associations of lower HL with the deterioration of mental or physical HRQoL after two years. In the adjusted model, patients with lower HL were not more likely to have deteriorated physical (low-HL patients: odds ratio/95% confidence interval: 0.99/0.53–1.84; moderate-HL patients: 0.97/0.55–1.73) or mental HRQoL (low-HL patients: 1.00/0.53–1.87; moderate-HL patients: 0.95/0.53–1.70) in comparison to high-HL patients. The HRQoL of lower-HL patients is worse at baseline but develops similarly to that of high-HL patients during dialysis treatment. Their relative HRQoL, thus, does not worsen further, but it does not improve either. Tailoring care to their needs may help to decrease the burden of low HL in dialysed patients.

Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients

Background Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1–5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25–2.33) for two comorbidities to 2.71 (2.00–3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16–2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients. Graphical abstract

Investigating the Use and Non-Use of Online Information Resources Among Cancer Patients: A Qualitative Study

This research focuses on examining the use and non-use of information resources among cancer patients. Non-seekers’ information-seeking behavior is analyzed in this research to determine the causes and symptoms of their non-seeking of health knowledge. Cancer patients use a variety of information resources such as the Internet, social media, and medical databases, in order to satisfy their needs. Studies showed that patients’ knowledge of their cancer stage might help them in making their care and treatment choices. Focus groups are commonly used in health research to explore the perspectives of patients or health care professionals; relatively few studies consider methodological aspects in this specific context. The purpose of this research is to investigate the information needs of cancer patients, and to find out reasons for the lack of cancer stage knowledge and desire for information after diagnosis. Expected findings include personal, situational, and psychological reasons, such as: low health literacy, low usage of health information, health instructions and the ways to increase patient awareness of the benefits and ways of seeking information.

COVID-19 Disparities and Vaccine Hesitancy in Black Americans: What Ethical Lessons Can Be Learned?

Objective This state of the art review focuses on bioethical questions and considerations from research findings and methodological issues, including design and recruitment of participants, in studies related to COVID-19 vaccine hesitation in Black individuals. Ethical concerns identified were applied to otolaryngology with recommendations for improving health inequities within subspecialties. Data Sources An internet search through PubMed, CINAHL, and socINDEX was conducted to identify articles on COVID-19 vaccine hesitation among the Black population between 2020 and 2021. Review Methods A systematic review approach was taken to search and analyze the research on this topic, which was coupled with expert analysis in identifying and classifying vital ethical considerations. Conclusions The most common COVID-19 vaccine hesitation factors were related to the development of the vaccine, mistrust toward government agencies, and misconceptions about safety and side effects. These findings raised bioethical concerns around mistrust of information, low health literacy, insufficient numbers of Black participants in medical research, and the unique positions of health professionals as trusted sources. These bioethical considerations can be applied in otolaryngology and other health-related areas to aid the public in making informed medical decisions regarding treatments, which may reduce health inequalities among Black Americans and other racial and ethnic minority groups. Implications for Practice Addressing ethical questions by decreasing mistrust, tailoring information for specific populations, increasing minority representation in research, and using health professionals as primary sources for communicating health information and recommendations may improve relationships with Black communities and increase acceptance of new knowledge and therapies such as COVID-19 vaccination.

Health Literacy in the Canton of Zurich: First Results of a Representative Study

Managing health information and services is difficult for nearly half of the population in Switzerland. Low health literacy has been shown to result in poorer health and health outcomes as well as a higher utilization of health services. To date, studies on health literacy in Switzerland have focused on a national level. However, Switzerland is a federal state with 26 cantons and a strongly decentralized health system. Therefore, the aim of this study is to understand how health literacy is distributed within the population of the canton of Zurich specifically, and to develop methods to determine whether an individual has a higher or lower level of health literacy. There were a total of 1000 participants in this representative study. Data was collected by an adapted version of the HLS-EU-Q47 and additional sociodemographic questions. The majority (56%) of the reported difficulties concerned accessing, understanding, appraising, and applying health information. The findings confirm that health literacy follows a social gradient, whereby financially deprived individuals and those with a low educational level report lower health literacy. The need for action to strengthen the health literacy of these population groups is therefore urgent. Interventions should pay particular attention to these vulnerable groups and tailor resolutions to their needs and preferences.

Shared Decision-Making and Colorectal Cancer Screening Behaviors Among Older Adults With Low Health Literacy

National guidelines recommend adults >75 engage in shared decision making (SDM) around colorectal cancer (CRC) screening because of the uncertain benefit to risk ratio. There are no decision tools to support CRC decision making for adults >75 years with low health literacy (LHL). The purpose of this mixed-methods study was to better understand the perspectives of adults >75 with LHL on SDM around CRC screening and to obtain their feedback on an existing higher literacy CRC decision aid. Utilizing the Brief Health Literacy Screening Tool to identify participants with LHL, semi-structured interviews were conducted with 30 adults. Findings indicate that 80% of participants were non-Hispanic Black and 42% had < high school degree. 76% felt they would benefit from CRC screening despite their age. Themes related to CRC screening included lack of knowledge of options and harms, but a desire to understand more to better take care of their health.

The Intersection of Cancer, Geriatrics, and Gerontology: A Multidisciplinary Approach Across the Cancer Continuum

Despite the majority of cancer survivors being older adults, the connection between oncology, geriatrics, and gerontology remains unexplored. Our symposium will provide insights across the cancer continuum from prevention through survivorship as well as a comprehensive view of the connection between gerontological and geriatric factors in oncology. Specifically, we will discuss the biopsychosocial and behavioral factors among older adults with cancer, their effect on health outcomes, and how researchers and clinicians can intervene to improve health outcomes. The first abstract by Dr. Cadet found that despite a lack of knowledge of options and harms of cancer screening among older adults with low health literacy, there was a desire to understand more to better their health. The second abstract by Dr. Bhattacharyya found that older patients with cancer experience high levels of social isolation, loneliness, and fear that are heightened by individual and technology-based barriers to telehealth. The third abstract by Dr. Carroll found that breast cancer survivors with good sleep quality had less accelerated biological aging than those with sleep problems. The fourth abstract by Dr. Krok-Schoen utilized one of the largest datasets of older women, the Women’s Health Initiative, and found multiple gerontological and geriatric factors associated with physical activity among older female cancer survivors. Closing this symposium is Dr. Guida, a Program Director at the National Cancer Institute (NCI), who will profile the current research efforts, programmatic priorities, and current funding in aging and cancer. These multidisciplinary researchers and clinicians will provide a comprehensive symposium regarding geriatric oncology.

Increased Self-Efficacy among Older Adults Aging-in-Place during COVID-19

Self-efficacy is defined as a person's belief in their capacity to execute behaviors necessary to produce specific performance attainments. It also reflects confidence in the ability to exert control over motivation, behavior, and environment. During the COVID-19 pandemic, older adults were stressed with forced isolation, concerns over mortality, and finding alternate means of fulfilling their home-based needs. We sought to assess how COVID-19 pandemic affected the self-efficacy of a cohort of older adults aging-in-place. The LITCOG cohort is a group of community-dwelling older adults (65 years and older) who have had longitudinally assessment of cognition, health literacy, and functional skills over the past 15 years. As part of a larger study of the LITCOG cohort assessing decision making for aging-in-place, we assessed self-efficacy using validated PROMIS (Patient-Reported Outcomes Measurement Information System) measures with older adults prior to COVID-19 and during the COVID-19 pandemic. Survey results were obtained from 214 subjects (n=66 pre-COVID and n=148 during COVID). Nearly half of the sample (48.2%) had either marginal (25.5%) or low health literacy (22.7%). PROMIS General Self Efficacy was higher among those assessed during the COVID-19 pandemic (45.8 (7.7) pre-COVID vs 43.7 (8.0), p=0.07). PROMIS Self Efficacy for managing social interactions was higher during the COVID pandemic (45.0 (6.1) pre-COVID-19 vs. 48.7 (8.3) during COVID-19, p=0.02). During the stress and social isolation of the COVID-19 pandemic, older adults exhibited increased levels of self-efficacy. Ongoing longitudinal follow-up will determine how this self-efficacy evolves after the COVID-19 pandemic and impacts the ability to age-in-place.

Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center

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.