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Health Literacy

Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."1 The skills required encompass reading, listening, analytics, numeracy, and decision-making, plus the ability to navigate a complex and changing healthcare delivery system. Healthcare providers, patients, and other stakeholders have important roles in health literacy.

According to the Centers for Disease Control and Prevention (CDC):2

Anyone who provides health information and services to others, such as a doctor, nurse, dentist, pharmacist, or public health worker, also needs health literacy skills to

  • 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

 

Given the increasing complexity of cancer diagnosis, treatment, follow-up with survivorship care plans, health literacy is integral to delivery of patient-centered care.

1. Nielsen-Bohlman L, Panzer AM, Kindig DA (eds). Health Literacy: A Prescription to End Confusion. Institute of Medicine Committee on Health Literacy. Washington, DC: National Academies Press; 2004.
2. Centers for Disease Control and Prevention. What is Health Literacy? 

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With this education project ACCC seeks to help cancer programs across the country to improve survivorship programming through the application of the health literacy principles.
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Virtual Reality Brings Patient Education to Life


June 23, 2021
Douglas Holt Headshot

This blog post is the first of a seven-part series highlighting the achievements of the 2021 ACCC Innovator Award Winners before their in-depth sessions at the ACCC 38th National Oncology Conference. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us live in Austin, Texas, October 20-22, 2021.

Effective patient education helps patients better understand their diagnoses and participate in shared decision-making with their providers. Traditionally, such education has taken the form of oral communication during office visits, with some video and reading components incorporated into post-appointment materials. But Douglas Holt, MD, chief resident of radiation oncology at the University of Colorado Cancer Center, UCHealth-Oncology Services, is taking patient education to the next level: virtual reality. “Patients really don't have a good understanding of what's happening within their bodies, and it's something that I think has plagued medicine for a long time,” Dr. Holt explains. “There's some great studies showing that verbal teaching alone is the least effective teaching method. And that's what we predominantly use in medicine.”

Patients often do not have the education necessary to fully understand the scope of their disease—what their MRI and CT images show, why they are experiencing certain symptoms, and why their specific treatment plan was selected. Engaging education materials can help patients more actively participate in their care, decreasing their anxiety and helping improve their treatment adherence.

The problem, says Dr. Holt, is that many providers in medicine, including oncology, think that patients do not want to know about their disease and treatment in depth, because receiving too much information may scare them and place a heavier burden on patients and their families. But Dr. Holt says providers who educate their patients during office visits may overestimate how well they can teach patients during those short time windows. “This is a blind spot for physicians,” says Dr. Holt.

This is especially true for providers in radiation oncology, he adds. “We're treating with invisible x-rays and targeting something [a tumor] in the body that patients don't already understand,” says Dr. Holt. “We might as well be speaking a foreign language.”

To better engage patients in their cancer treatment, Dr. Holt has employed virtual reality (VR) to give patients a concrete visualization of what is actually happening in their bodies. He takes patients’ CT scans (or individual image slices) and stacks them on top of one another to form a three-dimensional image of the patient and their tumor. With VR headsets and state-of-the art computers, patients gain a better understanding through a clear visualization of their tumor: where it is located in the body, what organs it is near, and how large it is. Patients step into the virtual reality space with Dr. Holt and their caregiver(s), where he can also visually demonstrate to patients how their radiation treatment plan will work, showing them the size of the radiation beam and where it will be targeted. Going beyond two-dimensional images and verbal explanations, this tool gives patients much-needed intuitive context about their disease and treatment. As patients come face-to-face with their disease, they can better advocate for themselves and their health.

Developing this technology, including the virtual reality software and a transportable cart of headsets and computers, took time and buy-in from various members of Dr. Holt’s cancer care team. Funded by a grant from the Colorado Cancer Coalition and one from the University of Colorado Cancer Center’s radiation oncology department, Dr. Holt partnered with Colorado State University in December 2019 to improve its VR software to meet the needs of the cancer center. The university’s software needed to be able to transpose patients’ images and scans into a virtual, three-dimensional space within any clinic room in the cancer program. To deploy his tool, Dr. Holt purchased state-of-the-art computers and headsets that could be moved room to room via a portable cart. By August 2020, the VR cart was ready for a pilot program.

Since first implementing this new technology, Dr. Holt says patients have been nothing but positive about their experience with it: “I had a 95-year-old woman who said, ‘I've had breast cancer for four years, and this is the first time I finally understood it.’ In my research, more than 80 percent of patients have said VR is the best educational tool they've come across.” Using VR to educate patients, Dr. Holt says that patients are more enthusiastic about starting their treatment and adhering to their systemic therapy. “Something else that was really surprising was how positive it was,” he explains. “We're looking at cancer, we're looking at patients’ mortality, and they would comment on how positive and how good it is just to see what they're facing and how we are going to treat it.”

As Dr. Holt continues to study the effectiveness of virtual reality in oncology patient education and makes improvements to the VR cart, he hopes to see this new technology become a standard of care. “I really think it's going to be the best educational tool and interface from physicians to patients,” he explains. “There's still a lot of things to be improved upon for this to be scaled. The hope is to keep continuing to develop the technology to make it something that will eventually become the standard of care for consultations with patients.”

Attend the ACCC 38th National Oncology Conference to learn more about how Dr. Holt developed and implemented virtual reality technology to improve patient education. Other topics to be addressed by 2021 ACCC Innovator Award winners include addressing costs of care and financial toxicity with a mobile app and developing an integrated health team that provides clinical interventions and wellness checks in patients’ homes.