Health Literacy in Pre-operative Gastrointestinal Cancer Patients Who Utilized Their Health Literacy, Starting from Initial Detection of Symptoms to Cancer Diagnosis

Nakagami, Katsuyuki; Akashi, Keiko

doi:10.5630/jans.30.3_13

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…Thus, our study is the first to establish an association between low HL and having a long PCI. A few studies have found that HL may influence mechanisms with regard to help-seeking behaviour (the patient interval) (McEwan et al, 2014;Nakagami & Akashi, 2010). The present study adds to this body of knowledge by indicating that the patients' health literacy may also influence the diagnostic process after initial help-seeking in general practice.…”

Section: Discussionsupporting

confidence: 51%

Patients' health literacy is associated with timely diagnosis of cancer—A cross‐sectional study in Denmark

Petersen

Laursen

Jensen

et al. 2021

European J Cancer Care

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Objective: Timely diagnosis of cancer is important for prognosis. Patients' health literacy (HL) may impact differences of diagnostic delays. Thus, we aim to explore the association between HL and diagnostic intervals in cancer.Methods: Questionnaire data were obtained from patients with cancer diagnosed in 2016 and their general practitioner (n = 3890). The primary care interval (PCI) and the diagnostic interval (DI) were calculated using dates from national registries and questionnaires. A long PCI and DI were defined as ≥75th percentile. HL was assessed using scales from the Health Literacy Questionnaire: engaging with healthcare providers (scale 6:Engagement, n = 3008), navigating in healthcare (scale 7:Navigation, n = 2827) and understanding health information (scale 9:Knowledge, n = 3002). Low HL was defined as a score ≤3.Results: Low HL was reported by 12.2% (Engagement), 27.0% (Navigation) and 9.3% (Knowledge) of the patients and associated with a long PCI after adjustment of socioeconomic factors: Engagement (prevalence rate ratio [PRR] 1.27 [95% CI 1.01-1.60]), Navigation ) and Knowledge (PRR 1.32 [95% CI 1.03-1.68]). No association was found between HL and DI.Conclusion: HL may interfere with the diagnostic processes in general practice.Efforts to manage low HL include GPs' awareness of patients' ability to explain and respond to bodily changes and use of corresponding safety-netting strategies.

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Section: Discussionsupporting

confidence: 51%

Patients' health literacy is associated with timely diagnosis of cancer—A cross‐sectional study in Denmark

Petersen

Laursen

Jensen

et al. 2021

European J Cancer Care

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“…total interval) was 8.82 months ( SD ± 11.41, range 1–48 months). The two qualitative studies did not seek to quantify the time from symptom onset to diagnosis, although patients’ narratives were used to demonstrate how the time to diagnosis may be influenced (McEwan et al, ; Nakagami & Akashi, ). Participants included in the qualitative study by McEwan et al were sampled from a prior quantitative study assessing the time to diagnosis in breast cancer patients.…”

Section: Resultsmentioning

confidence: 99%

“…Table 3 summarises the methodological quality of the studies, which ranged from poor to adequate. Study details such as setting, sampling strategy and exclusion criteria were poorly described, with only one study fully describing the participant inclusion criteria (Nakagami & Akashi, 2010). The small sample sizes impacted the analysis, with Nakagami and Akashi unable to reach theoretical saturation based on the grounded theory approach used (Strauss & Corbin, 1998).…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…The small sample sizes impacted the analysis, with Nakagami and Akashi unable to reach theoretical saturation based on the grounded theory approach used (Strauss & Corbin, 1998). From the reporting of the qualitative studies, it was also unclear whether the data accurately reflected the voices of most participants or a minority (McEwan, Underwood, & Corbex, 2014;Nakagami & Akashi, 2010). While acknowledging the limitations in the study design and conclusions, studies were not excluded based on the quality assessment alone.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

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The influence of health literacy on the timely diagnosis of symptomatic cancer: A systematic review

et al. 2018

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Low health literacy has been associated with poor cancer screening uptake, difficulty in making treatment choices and reduced quality of life following a cancer diagnosis, yet it is unclear whether and how health literacy influences the pathway to diagnosis for patients with cancer symptoms. This systematic review aimed to evaluate the influence of health literacy on the timely diagnosis of symptomatic cancer. Literature was searched between January 1990 and May 2017 using MEDLINE, Embase, Scopus, ASSIA, CINAHL and PsycINFO. Only three papers met the inclusion criteria. These reported two qualitative studies and one quantitative, with adult patients diagnosed with gastrointestinal (colon, rectum and pancreas), cervical and breast cancer. The definition and assessment of health literacy varied between the studies, as did the descriptions of the pathway to diagnosis. Due to the methodological weaknesses identified, the conclusions are limited; however, the studies did highlight important considerations in the definition and measurement of health literacy. Further research is required that clearly defines health literacy and follows the principles of the Aarhus Statement to assess the influence of health literacy on the pathway to cancer diagnosis. The protocol for this review was registered with PROSPERO (CRD42016048917).

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“…Relatively little information exists about how patient understanding and health literacy affect the timely diagnosis of symptomatic cancer, with some indication that processes of monitoring and evaluating symptoms may affect the time to diagnosis. 13 , 14 Cancer, being one of the most complex and challenging diseases, presents unique difficulties for patients in comprehending diagnostic pathways and treatment options. Studies have shown that patients often face significant challenges in understanding cancer‐related information, associated with suboptimal care.…”

Section: Introductionmentioning

confidence: 99%

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

Black,

Moreland,

Fulop

et al. 2024

Health Expectations

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IntroductionPeople being investigated for cancer face a wealth of complex information. Non‐specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner ‘gut feeling’, who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways.MethodsThis study employed ethnographic methods across four hospitals in England, including interviews, patient shadowing and clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy.ResultsOur analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge.ConclusionWe have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help‐seeking post‐discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtesting or inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors.Patient or Public ContributionPatient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.‐A. M.) was involved in data analysis and writing the manuscript.

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Health Literacy in Pre-operative Gastrointestinal Cancer Patients Who Utilized Their Health Literacy, Starting from Initial Detection of Symptoms to Cancer Diagnosis

Cited by 3 publications

References 5 publications

Patients' health literacy is associated with timely diagnosis of cancer—A cross‐sectional study in Denmark

Patients' health literacy is associated with timely diagnosis of cancer—A cross‐sectional study in Denmark

The influence of health literacy on the timely diagnosis of symptomatic cancer: A systematic review

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

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