3D radiotherapy planning resulted in superior treatment plans but we were unable to demonstrate a significant benefit in clinical outcomes. Prospective study designs are needed to describe the contemporary expectation of palliative radiotherapy for bone metastases in the modern era of 3D planning.

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The Canadian Council on Learning estimates that 60% of Canadian adults aged 16 and older and 88% of seniors aged 65 and older is health illiterate. Health literacy is the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course. Poor health literacy has a negative impact on health, contributing to a low quality of life and poor health outcomes. It is associated with increased use of healthcare resources and costs an estimated three to five percent of the total health care budget. Also, limited health literacy contributes to communication gaps within health care delivery. There have been a few studies that found relatively low levels of awareness and understanding of health literacy among health care professionals and a tendency to overestimate the health literacy of their patients. In addition to being unable to identify patients with limited health literacy, healthcare providers may not know how to respond when faced with patients with limited health literacy. The goal of this cross-sectional exploratory study is to contribute to the understanding of health literacy of healthcare providers, which in turn will help with patient education and patient self-management. It is focussed on ascertaining healthcare providers' perceptions, general knowledge, and understanding of the concept of health literacy, surveying their techniques used to facilitate care and education for patients, and exploring their understanding of limited health literacy and its management. Methods: Healthcare providers were recruited from a community based cancer centre that includes medical radiation therapists, radiation oncologists, oncology nurses, social workers, and dietitians. This mixed methods research study consisted of a 23 item web based survey that focussed on healthcare providers within a radiation oncology department. Results: Quantitative and qualitative analyses revealed that only 50% of the respondents recognized the term health literacy, a third correctly guessed the prevalence of limited health literacy rates in Canada, 45% expected their patients to have a basic understanding of health, and 84% would like more training on health literacy including assessment tools and techniques to manage limited health literacy. 84% correctly believed that higher education levels have no impact on an individuals' health literacy. About 75% of the respondents assess patient understanding almost always or often. Respondents' definitions of health literacy included understanding, ability, decision-making, terminology, information, knowledge, health, and self. Respondents outlined barriers to effective assessment which mainly indicated a lack of knowledge or awareness either in terms of not knowing how to assess health literacy, not knowing what health literacy means, or a lack of awareness surrounding its need. Conclusions: The study highlighted a lack of awareness and understanding of health literacy which needs to be addressed through...