Do Patients Understand Radiation Therapy? Radiation Oncology Knowledge Assessment and Health Literacy among Culturally Diverse Breast Cancer Patients at a Safety-Net Hospital

Abstract

<h3>Purpose/Objective(s)</h3> Comprehensive understanding of oncologic treatment is essential for shared decision-making and has been shown to improve health outcomes and quality of life in patients with breast cancer. However, comprehension and retention of information in radiation oncology consults is poorly understood, particularly among Spanish-speaking patients at safety net hospitals. The purpose of this study was to examine post-consultation radiation oncology knowledge and health literacy among culturally diverse breast cancer patients. <h3>Materials/Methods</h3> After consultation for curative breast radiotherapy (cT1-4N1-3M0), the Radiation Oncology Knowledge Assessment Survey (ROKAS) was administered to Spanish- and English-speaking patients ≥ 18 years old, from January 2021 to January 2022 at a safety-net hospital. Radiation knowledge was assessed using the ROKAS and included items involving the site and purpose of treatment, logistics of simulation, number of fractions, and short and long-term side effects. Additional independent variables included validated questionnaires related to health literacy, health numeracy (numerical medical concepts), acculturation (assimilation to the dominant culture), and socioeconomic factors. Items regarding satisfaction with consultation, language interpretation, and understanding treatment were also included in the survey. Bivariate Pearson correlations were conducted to examine the relationship between the independent variables and post-consultation radiation knowledge. <h3>Results</h3> Fifty ROKAS were obtained from 25 Spanish- and 25 English-speaking breast cancer patients (median age 57 [IQR 49.75-62.25]). While 92% of Spanish-speaking and 96% of English-speaking patients agreed or strongly agreed with satisfaction with consultation, language interpretation, and understanding treatment (p=0.60), radiation knowledge questions were frequently missed. The most missed radiation knowledge items included the long-term side effects of arm swelling (n=40); skin (n=30), heart (n=19), and lung (n=13) toxicities; fractionation number (n=14); and the location of where radiation kills cancer cells (n=13). Post-consultation radiation knowledge was positively correlated with higher health literacy (p=0.048), acculturation (p=0.014), and health numeracy (p=0.027), as well as English-language preference (p=0.024) and a higher education level (p=0.023). <h3>Conclusion</h3> Post-consult radiation knowledge was significantly associated with health literacy, health numeracy, and acculturation among breast cancer patients. As such, providing patients with comprehensible medical information while accounting for individual health literacy, is crucial to improve shared decision making between patients and providers in a culturally diverse population.