Customizable Health Literacy Appropriate Patient Education Materials: The Impact on Patient Satisfaction

Abstract

Patient education materials (PEMs) empower patients to understand their diagnosis/treatment options and improve patient-provider communication. Current PEMs in radiation oncology are primarily text heavy or multiple-click Internet resources, exceeding the national recommendation of a 6th grade reading level. This prospective IRB-approved single institution trial assessed if a customizable health-literacy appropriate PEM improved patient satisfaction during consultation for lung cancer treatment. We hypothesized use of the PEM would improve patient satisfaction. All English or Spanish speaking adults scheduled for consultation during multidisciplinary lung cancer clinics were eligible for recruitment into this study. Weekly block randomization assigned patients to the control (standard of care encounter) vs. intervention group (standard of care and PEM). Patients completed a post-encounter survey covering sociodemographics, validated health literacy and satisfaction questions. Patient satisfaction was measured on a 5-point Likert scale. Descriptive statistics described the score in two groups, and t-tests or chi-square tests were used for between group comparisons as appropriate. Among 82 participants, there was no difference in overall patient satisfaction between control and intervention cohorts, with means of 4.7 and 4.3 (p = 0.07) respectively and a median of 5 for both groups. When stratified by health literacy, those with adequate levels were more satisfied having received the PEM (100% vs. 91.7%), whereas those with limited/marginal health literacy levels were less satisfied with the PEM (84.6% vs 96.4%). When assessing satisfaction with communication, there was some evidence that patients in the intervention cohort were more likely to disagree that doctors used medical words without explanation; however, this did not reach conventional levels of significance. The intervention group more often disagreed with the statement "I was allowed to say everything that was important to me" compared to the control, reported as mean scores of 4.29 vs. 4.63 (p = 0.04). The PEM did not improve overall patient satisfaction during consultations. Results could be confounded by the survey design. While efforts were made to ensure PEM readability was at an appropriate health literacy level, the assessment measure did not adhere to these guidelines, which may explain why patients with lower health literacy appear less satisfied. Introducing PEMs requires a balance between allowing patients the opportunity to feel heard while providing digestible information. With no evidence of detriment and some early signal of improved satisfaction in terms of communication when utilizing the PEM, efforts are underway to expand this resource to breast and head and neck cancers.