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Disparities in Surgical Oncologic Care

E132: Providers’ Perspectives on Health Literacy and Surgical Cancer Care

Introduction: Disparities exist in cancer care among patients in the Deep South. Low health literacy is prevalent in this region and is associated with longer length-of-stays and higher rates of complications and readmissions. A better understanding of the role that health literacy plays during the surgical journey is needed.

Methods: We conducted semi-structured interviews of healthcare workers involved in the care of gastrointestinal cancer patients. Participants were recruited using convenience sampling and a snowball-recruitment approach. The interview guide was structured to focus on all domains of access to care during the surgical journey. Three coders coded verified interview data with NVivo 12.6 Plus using inductive thematic analysis and content analysis approaches. The team established inter-coder agreement at 90% and a working codebook was developed. A constant comparative method was employed to ensure that saturation in the data was achieved.

Results: 27 healthcare workers were interviewed, including surgeons (n=11), medical oncologists (n=2), radiation oncologists (n=2), nurses (n=8), patient navigators (n=3) and a primary care physician (n=1). The figure represents the themes that emerged around the role of low health literacy in each of the three phases of the surgical journey with representative quotes. In the preoperative phase, low health literacy contributes to delays in care, patients’ difficulty in understanding diagnosis, patients’ difficulty facilitating their own care, and difficulty understanding costs/insurance. In the perioperative phase, low health literacy contributes to difficulty understanding treatment plans and refusing aspects of care due to lack of understanding, and it creates a barrier to compliance to staged treatments. In the postoperative phase, low health literacy contributes to difficulty understanding postoperative complications and when to seek help and the need for more oversight for follow up. Common subthemes across these surgical phases included difficulty following instructions and the usefulness of visual aids, repetition and teach-back method for patients with low health literacy

Conclusions: Cancer providers highlighted the role of low health literacy in all phases of the surgical journey, particularly in creating barriers to understanding key components such as diagnosis, treatments, complications and instructions. Future studies should focus on understanding health literacy from cancer patients’ perspectives and on improving our education for low health literacy patients at each phase of the surgical journey.

Learning Objectives:

  • describe barriers to quality surgical cancer care for patients with low health literacy
  • discuss the need for improved surgical education for patients with low health literacy
  • recognize the role of health literacy in creating disparities among patients undergoing surgical cancer care