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Incorporating Health Literacy in ALL Patient Education

Mohamed Hersi, PharmD, BCPS

February 14, 2019
As part of a multidisciplinary team education project on acute lymphocytic leukemia (ALL), ACCC recently released an environmental scan that provides an overview of the current landscape for ALL diagnosis and treatment, along with potential opportunities to improve care for this patient population. In this final post in a three-part series, guest blogger Mohammed Hersi, PharmD, BCPS, describes the role an oncology pharmacist can play in providing and reinforcing patient education with attention to the patient's health literacy and cultural considerations.

Pharmacists play an integral role in the delivery of care for all patients. They are one of most accessible healthcare professionals in the community and are medication experts. In the specialty areas of hematology and oncology, pharmacists are involved in direct patient care; their responsibilities may include ensuring safe compounding and delivery of medications, minimizing waste, participating in the clinical decision-making process, collaborating for patient education, and engaging in many aspects of drug development and research. I would specifically like to focus on an often overlooked aspect of patient care in this very complex setting, health literacy and patient education for individuals with cancer. 

There are often misconceptions regarding patients’ understanding of information communicated to them about their health. Put simply, how can we be sure that our patients really understand the education we provide? As cancer care providers, we should keep in mind that only an estimated 12 percent of English-speaking adults in the United States have proficient health literacy skills. By assessing a patient’s health literacy, we help lay the groundwork to assure that the patient fully comprehends the information provided—whether transmitted verbally, in print, through an interpreter, or other means.

Health literacy has been defined as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Many personal and systemic factors—such as education level, culture, situation, and context—affect an individual’s health literacy, which, in turn, impacts patients’ ability to navigate their health resources, engage in self-care, and understand concepts needed to make informed health-related decisions. Health literacy has been shown to affect patience compliance, adherence to therapy, and health outcomes. (For more on health literacy for the cancer care team visit the ACCC website.)

No Simple Matter
Cancer diagnosis and treatment regimens are very complex and can be difficult to understand for many people regardless of their educational background or health literacy level. Over the past decade, oncology has experienced exciting advances that have led to new therapies, new delivery methods, and more treatment options—from the introduction of oral anticancer agents to new immunotherapies for a number of cancers. Whether anticancer treatment is administered in the clinic with pharmacists, nurses, and other providers present, or as an oral agent to be self-administered at home, most patients struggle in dealing with the treatment-related side effects and complications that can occur after they leave the healthcare setting.

Adult patients diagnosed with acute lymphocytic leukemia (ALL) face a cancer treatment regimen that is complex and lengthy. For patients with ALL, a pharmacist can and should be included in such pivotal areas as transitions of care, minimizing adverse events, providing patient-specific education, and in empowering patients to be able to identify and report to the care team any side effects that may warrant an intervention.

Continuing Education
Transitions of care are key touchpoints in the patient’s care with the potential to impact compliance with treatment and health outcomes. When a patient is discharged from the inpatient setting of care, pharmacists should be involved in the discharge medication reconciliation review in an effort to minimize polypharmacy, drug interactions, and drug-disease interactions. Furthermore, this medication reconciliation review should be ongoing given that multiple providers may be involved in the patient’s care.

Pharmacists can also play a role in providing patient-specific education that is tailored to the individual’s health literacy level. For patients and caregivers, understanding how to identify chemotherapy-induced nausea and febrile neutropenia—common and critical side effects—and knowing when and how to provide self-care, when to contact the provider, and when to go the emergency department is imperative. To address the issue of nausea and vomiting, pharmacists may assist in developing patient-specific scheduled anti-emetics that take into consideration drug interactions, dose adjustments, and pharmacokinetics parameters. For febrile neutropenia, a serious complication that is prominent in some chemotherapy regimens, patients should be educated and understand that time is of the essence in identifying the initial signs and symptoms. 

Cancer-specific education that includes comprehension assessment should empower patients and caregivers to understand, anticipate, and—when appropriate—manage side effects and complications, as well as to know when to seek immediate medical attention. To achieve this, the cancer care team must be aware of the appropriate health literacy tools needed to develop and implement patient-specific education and information materials to be used before, during, and after treatment. Resources on health literacy for cancer teams are available from:

In summary, as the treatment for ALL continues to advance, so will the need for pharmacists’ involvement in patient education. Health literacy is a critical component of patient-centered care delivery that has been demonstrated to impact patient compliance and outcomes. As such, every patient education session should incorporate some assessment of health literacy and the appropriate tools needed to provide clear, effective education that will empower patients to understand and participate in their own care.   

Guest blogger Mohamed Hersi, PharmD, BCPS, joined the clinical pharmacy staff at Memorial Hermann Memorial City Medical Center in 2013. His areas of interest include internal medicine and oncology. Dr. Hersi serves on the Advisory Committee for the ACCC Multidisciplinary Acute Lymphocytic Leukemia education project.

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