Documenting limited health literacy in a clinical setting

Empowering Recovery: A Co-Designed Intervention to Transform Care for Operable Lung Cancer

BACKGROUND

Patients undergoing surgery for lung cancer experience significant symptom burden and physical impairments. Exercise rehabilitation programmes have been shown to improve symptoms and aid recovery, however, implementation into routine practice has proven challenging.

OBJECTIVE

To develop a robust understanding of the key design requirements of an exercise-based pre- and post-operative rehabilitation prototype intervention designed to support patients with operable lung cancer prepare for and recover from thoracic surgery, and co-design an acceptable intervention prototype with key stakeholders.

DESIGN, SETTING AND PARTICIPANTS

An experience-based co-design (EBCD) study involving patients, caregivers, clinicians, consumer advocates and researchers from across Australia. Two rounds of EBCD workshops were held between November 2023 and May 2024. Workshops were underpinned by the COM-B Model and Theoretical Domains Framework. Qualitative data were thematically analysed by two independent researchers. Identified barriers and facilitators were mapped to the Behaviour Change Wheel, and used to develop the final intervention prototype, which was presented using the Template for Intervention Description and Replication (TIDieR) guide.

RESULTS

Eleven patients (55% female, mean age 66.4 (±9.3) years), one caregiver, and 16 professionals (physiotherapists, nurses, respiratory physicians, a thoracic surgeon, consumer advocates and researchers) participated. Retention between workshop rounds was high (86%). Nineteen major themes were developed, including unmet education needs; the link between mental health and recovery; and the influence of unexpected, persistent symptoms and functional decline. Core intervention principles included flexibility, individualisation and continuity. Essential components included screening/assessment, education, exercise, behaviour change, and mental health support. The intervention prototype was refined in the second workshop round.

CONCLUSIONS

This EBCD study successfully identified key experiences and barriers in preparing for and recovering from lung cancer surgery and engaged stakeholders in complex intervention design, culminating in the development of a flexible, multi-modal pre- and post-operative rehabilitation programme prototype. Future projects will evaluate the prototype acceptability and feasibility.

PATIENT OR PUBLIC CONTRIBUTION

Past patients and their caregivers with lived experience of undergoing/caring for someone undergoing lung cancer surgery, and multidisciplinary professionals, participated in co-design workshops to develop and refine the exercise-based rehabilitation intervention goals, priorities, and prototype.

Identifying and exploring patient engagement interventions for people diagnosed with lung cancer: A rapid systematic review

PURPOSE

To identify and synthesise evidence describing patient engagement interventions that have been used to support people diagnosed with lung cancer.

METHODS

A rapid systematic review was conducted following guidance from the Cochrane Rapid Reviews Methods group and reported using the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) checklist. Keyword searches were performed in MEDLINE and supplemented by Google Scholar searches. Searches were restricted to peer-reviewed articles conducted in high-income countries and published in English. Data was extracted using the Template for Intervention Description and Replication (TIDieR) checklist, tabulated, and narratively synthesised. Data extraction and quality assessment were conducted by two independent reviewers.

RESULTS

Thirty-four studies were included in the final analysis. Studies show a positive impact of interventions across a range of engagement outcomes including patient and caregiver knowledge, patient activation, and decision making. Interventions were also shown to reduce healthcare use, reduce symptom severity, and improve psychosocial outcomes. Barriers to implementing interventions included: the timing/delivery of interventions, poor digital literacy, system and technical barriers, and poor uptake and adherence by advanced patients. Factors supporting intervention implementation included: participatory research/co-production approaches, providing training and support for those delivering interventions, involving caregivers, and employing broad recruitment strategies. The overall risk of bias for studies ranged from moderate to high.

CONCLUSION

The identified interventions demonstrate significant potential for enhancing patient engagement and improving outcomes for lung cancer patients. Findings from this review will support the design and implementation of future interventions to help people with cancer engage with healthcare.

REVIEW REGISTRATION

The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024521052) on 06/03/24.

Guided self-determination for patients with non-small cell lung cancer: Patients' experiences of a nurse-led person-centred intervention

PURPOSE

Guided self-determination is an empowering person-centred approach that has proven useful in empowering different patient groups but has not yet been tested in lung cancer patients. The purpose of the study was to examine how patients with stage III non-small cell lung cancer in concomitant chemoradiotherapy could benefit from a guided self-determination course.

METHODS

A prospective intervention study with both quantitative and qualitative data. Patients (n = 20) were offered four guided self-determination conversations with a nurse. Symptoms and quality of life were measured through questionnaires and semi-structured interviews elicited thirteen patients' experiences. Thematic analysis was conducted, and the Consolidated Criteria for Mixed Method Research was used for reporting.

RESULTS

No difference in quality of life were found but significant worsening of pain, dyspnea, diarrhoea and dysphagia. Six themes were generated describing that in a new, uncertain and lonely situation with a life-threatening disease, the patients appreciated a respectful relationship with a nurse, and conversations with the nurse became a lifeline. Some patients felt increasingly empowered through new insights, while others felt that it became too intimate.

CONCLUSION

When patients with a serious disease can draw on nurses' knowledge and experience, they are empowered to manage everyday life. Some patients need supportive and reflective conversations, while others benefit from concrete problem-solving objectives.

Health outcomes reported by healthcare providers and clients of a community-based medically tailored meal program

BACKGROUND

Medically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).

METHODS

Clients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients' body mass index, systolic blood pressure, and hemoglobin A1C. These health outcomes, measured at program intake and 3-6 months later, were linked with administrative data for 1,959 clients who completed at least two months of MTM services in 2020, 2021, and 2022.

RESULTS

Clients exhibited substantial heterogeneity in demographics and health status at intake. Self-reported malnutrition risk decreased significantly over program duration (p < .001). Nearly one-third of clients with poor health reported improvement over time. Over 60% of clients with obesity experienced stable BMI. Clients with hypertension experienced significant improvements in systolic blood pressure (p < .001). Clients with diabetes and available data (n = 45) demonstrated significant reduction in hemoglobin A1C (p = .005).

CONCLUSION

We found evidence that participation in MANNA's MTM program was associated with favorable health outcomes for clients with serious illness and nutritional risk. Community-based organizations can maximize the completeness of their data by focusing on routinely collected internal data like validated health screeners and surveys.

Parental Health Literacy and Acute Care Utilization in Children With Medical Complexity

OBJECTIVE

Health literacy is the ability to find, understand, and use information and services to inform health-related decisions and actions. Inadequate health literacy is associated with health disparities, poor health outcomes, and increased emergency department (ED) visits and hospitalizations. Children with medical complexity (CMC) have high rates of acute health care utilization. We examined the association of parental health literacy with acute care utilization and costs in CMC.

METHODS

This cross-sectional study included parents of CMC receiving primary care at a free-standing children's hospital. We measured parental health literacy using the Single Item Literacy Screener, which measures the assistance needed to read health care materials. Our main predictor was parental health literacy, categorized as adequate versus inadequate. In a sensitivity analysis, we categorized health literacy as never needing assistance versus needing any assistance. Main outcomes were annual ED visits, hospitalizations, and associated costs.

RESULTS

Of the 236 parents of CMC, 5.5% had inadequate health literacy. Health literacy was not associated with acute care utilization or associated costs. In our sensitivity analysis, CMC whose parents need any assistance to read health care materials had 188% higher ED costs (adjusted rate ratio 2.88 [95% confidence interval: 1.63-5.07]) and 126% higher hospitalization costs (adjusted rate ratio 2.26 [95% confidence interval: 1.49-3.44]), compared with CMC whose parents never need assistance.

CONCLUSIONS

Inadequate parental health literacy was not associated with acute care utilization. However, CMC of parents needing any assistance to read health materials had higher ED and hospitalization costs. Further multicenter studies are needed.

Examining the differences of perceptions and experience with online health information accessibility between deaf and hearing individuals: A qualitative study

OBJECTIVE

Describe and compare the experiences and preferences of Deaf and hearing individuals with different levels of health literacy in accessing, interpreting, and acting upon online health information.

METHODS

We conducted semi-structured interviews with 17 Deaf and 10 hearing participants with high and low health literacy from three healthcare sites. We conducted thematic analysis of the transcripts to explore information navigation experiences, information sources and dissemination preferences.

RESULTS

We found thematic differences between Deaf and hearing participants with high and low health literacy in terms of information needs, information search experiences, information search perceptions, and preferred information dissemination approaches. Relative to hearing counterparts, Deaf participants were more likely to encounter challenges in accessing and understanding online information. Deaf participants with low health literacy were more likely to rely on visual graphics to support their understanding of the information than those with high health literacy. Deaf participants advocated for tailored approaches to disseminate health information to Deaf communities.

CONCLUSION

Our findings suggest that differences in online health information navigation experiences and accessibility may inform disparities in health literacy outcomes between Deaf and hearing individuals.

PRACTICE IMPLICATIONS

Online health information should be presented in a manner accessible to Deaf community members.