Influence of Health Literacy on Treatment Adherence in Breast Cancer Care: A Scoping Review

Abstract

Background: Health literacy (HL) is an individual’s ability to interpret and effectively utilize health information. Low HL has been associated with poorer treatment adherence. The effect of HL on treatment adherence is important to understand when survival is closely tied with treatment, such as in breast cancer (BC). The aim of our review was to examine the influence of HL on treatment adherence in BC patients. Methods: A scoping review was conducted according to the Joanna Briggs Institute methodological framework. A comprehensive search was performed using 5 electronic databases to map the available literature. Studies were included that assessed BC patients’ HL with a validated instrument and associated this with treatment adherence. Results: Our review initially yielded 1404 studies. Of these, 9 studies (n=2468) met our inclusion criteria. Five studies (n=1478, 60%) found no association between HL and treatment adherence. Of the 3 studies (n=1175) focused on breast surgery decision-making, 2 studies (n=915, 77.8%) reported a positive association between HL and the decision to partake in reconstruction. In contrast, 3 (n=936) of 5 (n=1147) studies examining adjuvant therapy demonstrated that treatment decisions were not affected by HL. Conclusion: Although it is difficult to determine the relationship between HL and treatment adherence from the contrasting results of the available literature, HL may have a greater impact on surgical decision-making as compared to the receipt of adjuvant therapy. Additional research is required to better characterize the effects of HL on treatment adherence, including surgical decision-making.