Abstract
Access to breast cancer genetic counseling is suboptimal for patients with limited health literacy or a migrant background due to ineffective communication and lack of healthcare professionals’ recommendation. This study examines the effect of a blended training program (Erfo4all) for healthcare professionals on their awareness, knowledge, and self-efficacy towards communication about genetic counseling with patients with limited health literacy or a migrant background. In total, 59 breast surgeons and specialized nurses from 16 Dutch hospitals completed an online module and group training. Knowledge, self-assessed awareness, and self-efficacy were assessed before the training and 33 participants also completed a posttest questionnaire 6 months after the training program. We also assessed the perceived applicability and relevance of the training program from healthcare professionals’ perspectives. We found a significant increase in self-assessed awareness of the prevalence and impact of limited health literacy and in healthcare professionals’ self-efficacy to recognize limited health literacy and to communicate effectively with patients with limited health literacy or a migrant background. We did not find an increase in knowledge score. Almost all healthcare professionals reported that they use the techniques learned in the training, such as the teach-back method and plain language, and felt more confident discussing breast cancer genetic counseling. Our results suggest that a blended training program for healthcare professionals has potential to improve their ability to communicate effectively about breast cancer genetic counseling with patients with limited health literacy or a migrant background and offers a promising way to increase the referral rate for these groups of patients.
Highlights
Breast cancer, the most commonly diagnosed type of cancer, affects about 12% of women worldwide (Bray et al 2018)
The extent to which this training program increased: a) Healthcare professionals’ knowledge about the impact and prevalence of limited health literacy, awareness of the impact of limited health literacy on medical communication, their self-efficacy to recognize patients with limited health literacy and to communicate effectively about breast cancer genetic counseling b) Healthcare professionals’ awareness of the importance of taking into account cultural factors when communicating with patients with a migrant background and their selfefficacy in coping with these cultural factors and with language barriers
We developed a blended training program (Erfo4all) based on healthcare professionals’ and patients’ needs and preferences, to increase healthcare professionals’ knowledge, awareness, and self-efficacy when communicating about breast cancer genetic counseling with communication-vulnerable patients, i.e., patients with limited health literacy or a migrant background
Summary
The most commonly diagnosed type of cancer, affects about 12% of women worldwide (Bray et al 2018). Between 5 and 10% of breast cancers are associated with a hereditary predisposition. Pathogenic variants in the BRCA1 and BRCA2 genes are associated with about 20% of familial breast and ovarian cancers (Gorodetska et al 2019). A pathogenic variant may affect healthy family members, so genetic testing of breast cancer patients at risk of carrying a pathogenic variant is important (Byrski et al 2014; Godet and Gilkes 2017; Wevers et al 2012). Healthcare professionals (surgical oncologists, medical oncologists, and specialized nurses) should identify patients at risk of carrying a variant in a breast cancer gene (e.g., BRCA1, BRCA2, CHEK2, PALB2, ATM genes), inform them about genetic testing, refer
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