Tag Archives: health literacy

Heading in the Right Direction

By Virginia Vaitones, MSW, OCW-C

The demographics of cancer in the U.S. are shifting. As outlined in the 2013 IOM report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, our older population (age 65+) is continuing to expand as is the percentage of those ages 85 and above (from about 14% in 2010 to more than 21% in 2050). At the same time, our population is growing increasingly diverse.1 While our patient population evolves, advances in detection and treatment are bringing improvements to cancer care, while adding complexity.

All of these changes are taking place during a period of unprecedented transformation in our healthcare system.

It’s hardly surprising, then, that cancer care providers face a number of daunting challenges to their everyday delivery of care. For an example of this complexity, look no further than the proceedings from the latest National Academies of Science, Engineering, and Medicine’s Health Literacy Roundtable workshop, which discussed how to facilitate health communications with immigrant, refugee, and migrant populations by promoting health literacy and directly engaging these underserved communities.

As a result, cancer programs must constantly innovate and search for ways to provide the best care for patients. The final issue of Oncology Issues in 2017 features five very different articles focused on the common goal of promoting efficient and effective cancer care. In “The Community Health Worker,” ACCC Cancer Program member, Yuma Regional Medical Center Cancer Center, approached the challenge of communicating with their rural migrant population by hiring a community health worker to act as a liaison between cancer care services and the underserved.

There are so many ways to approach the ever-changing landscape of cancer care, but as I read through this issue’s articles, I realized that despite such seemingly disparate topics as community health workers, precision medicine, peer review for radiation therapy, multi-site integrated healthcare delivery, and disease site process mapping, they shared common themes:

  • Access
  • Communication
  • Patient experience
  • Coordination of care
  • Leveraging shared resources
  • Actionable data

Not too long ago, these themes were not at the forefront of our everyday practice concerns. We were operating in siloes, communication between departments was lacking, and data gathering was tedious at best. Instead of leveraging shared resources, the prevailing mindset was often “protect your turf.”

Today, our workplaces are not perfect. We still have a long way to go toward breaking down siloes and streamlining the collection of actionable data. As cancer care has become more complex and time and constraints have increased, effective communication among all members of the multidisciplinary cancer care team can be very challenging.

But after reading these articles, I was left hopeful. By tackling important issues proactively and looking for innovative solutions to new problems, ACCC member programs set examples for each other, share challenges and solutions, and by doing so, help elevate the quality of care nationwide.

If programs continue to strive in their own way to improve care in the areas reflected by these common themes, I’d say we’re headed in the right direction.

1. The National Academies of Sciences, Engineering, and Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Levit LA, Balogh EP, Nass SJ, Ganz PA. eds. Washington, D.C.: The National Academies Press; 2013.

Virginia Vaitones, MSW, OSW-C, is a past president of the Association of Community Cancer Centers (ACCC). Most recently, she served as chair of the ACCC Editorial Committee.

Cancer programs seeking to become health literate organizations, can use ACCC’s health literacy gap assessment tool to identify areas of strength and areas for improvement. Learn more

Are Your Patients Understanding You?

by Tricia Strusowski, MS, RN

We have all witnessed a newly diagnosed patient’s glazed-over expression as we review their cancer treatment plan. Often, patients are facing multiple referrals to different specialists and support staff, not to mention appointments for tests and procedures. While the patient tries to absorb all this information, we healthcare providers may further complicate things by using medical terminology. Recently at a patient and family focus group, a few patients shared with me that they wished their physician and healthcare team spoke to them in a way that they understood.

“I wish they spoke in plain language.”

“I didn’t understand all the appointments and what exactly they were for.” 

How can the patient navigator help?  The navigator is the educator for the patient and family.  Navigators identify the patient’s preferred learning style and review the treatment plan, appointments, tests, and procedures in an easy to understand manner.

Cancer diagnosis and treatment plans have become increasingly complex. At the same time, a core tenet of quality, patient-centered, value-based care is engaging patients in their own care and encouraging participation in shared decision-making.

Estimates are that close to 9 out of 10 adults are challenged in using everyday health information, that is, information that is provided in a variety of settings including healthcare facilities, through the media, and in their communities.1, 2, 3

According to the Centers for Disease Control and Prevention (CDC), health literacy skills are necessary for “Anyone who provides health information and services to others, such as a doctor, nurse, dentist, pharmacist, or public health worker,” so that they can:4

  • Help people find information and services
  • Communicate about health and healthcare
  • Process what people are explicitly and implicitly asking for
  • Understand how to provide useful information and services
  • Decide which information and services work best for different situations and people so they can act

Plain Language, Please

Plain language is communication that a person with cancer can understand the first time they read or hear it.  A plain language document is one in which, with reasonable time and effort, people can find what they need, understand what they find, and act appropriately on that understanding.

Key elements of plain language include:

  • Organizing your information so that the most important points come first
  • Breaking complex information into easy-to-understand chunks
  • Using simple language and defining technical terms
  • Using the active voice

Keep your audience in mind. Language that is plain to one set of readers may not be plain to others. Test any materials you’ve developed before, during, and after they are completed.

Speaking plainly is just as important as writing plainly. Many plain language techniques also apply to verbal communication.  For example, avoid jargon and take time to define and explain any technical or medical terms.

Another effective communication tool is a simple cancer patient appointment checklist. The checklist can include referrals to specialists, support services, tests and procedures, along with definitions of medical terms in plain language. Patients can take the appointment checklist home, review it, and then call the navigator with any additional questions. You can also create disease-site-specific appointment checklists.

Does Your Program Need a Health Literacy Check-Up?

ACCC’s health literacy initiative, Let’s Be Clear: Communicating to Improve the Patient Experience, offers a practical tool for assessing your cancer program’s health literacy and resources to strengthen your staff’s health literate communication skills.

Finally, I’ve included some guidelines for teaching health literacy so that healthcare providers can educate patients using plain language, here.

A diagnosis of cancer is frightening for patients and their families. The medical terminology and jargon we healthcare professionals often use not only increases their anxiety, but is also a barrier to engaging patients in their own well-being.

Let’s lessen the anxiety and improve the patient experience by using plain language and making organizational health literacy a priority.


  1. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Health literacy: A prescription to end confusion. Washington, DC: National Academies Press; 2004.
  2. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education, National Center for Education Statistics. 2006.
  3. Rudd RE, Anderson JE, Oppenheimer S, Nath C. Health literacy: An update of public health and medical literature. In JP Comings, B Garner, C Smith, eds. Review of adult learning and literacy (Vol. 7)  Mahwah, NJ: Lawrence Erlbaum Associates; 2007:175-204.
  4. Centers for Disease Control and Prevention. What is health literacy? Available at https://www.cdc.gov/healthliteracy/learn/index.html. Accessed December 5, 2017.

ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.