Exploring nursing challenges to providing support and understanding

PATIENTS WITH CANCER REPRESENT A POPULATION with unique health literacy needs. The complexity of managing cancer combined with rapidly growing treatment options requires patients to make difficult decisions that can be physically and emotionally distressing (Amalraj, Starkweather, Nguyen, & Naeim, 2009; Ballard & Hill, 2016). This may affect a patient’s ability to access healthcare services, use preventive measures, follow medical advice, and receive treatment to meet his or her needs (Amalraj et al., 2009; Ballard & Hill, 2016). Health literacy is multifaceted and includes cognitive, social, and navigational skills such as language proficiency, reading and numeracy skills, understanding risk and probability, and the communication skills needed to interact with healthcare providers (Eadie, 2014; Lambert & Keogh, 2014). Limited health literacy has been linked with poor disease management, nonadherence to treatment recommendations, increased hospitalizations, and patient or caregiver medication errors (Christensen, 2016; Eadie, 2014). In addition, when health literacy needs are not met, patients report a lack of understanding about their disease, have difficulty making decisions, have fears of dying, experience unexpected symptoms, and may rely on other sources to fill gaps in understanding (Cohen, Jenkins, Holston, & Carlson, 2013). Health literacy is defined as an individual’s ability to receive, acquire, understand, and use information (Smedley, Stith, & Nelson, 2003). Nurses should assume all patients and families have low health literacy and difficulty understanding (e.g., assume a universal precautions approach), and, as such, the U.S. National Library of Medicine recommends a sixth-grade reading level for patient education (Ballard & Hill, 2016; Protheroe & Rowlands, 2013; U.S. National Library of Medicine, n.d.). As patient advocates, nurses must attend to varying levels of health literacy among patients and families (Eadie, 2014; Protheroe & Rowlands, 2013). Figure 1 provides an overview of nursing standards and national reports emphasizing health literacy as an essential component of quality nursing care. Effective methods for giving patients understandable and retainable information about their care have been identified as a priority for oncology nursing research (Cox, Arber, Gallagher, MacKenzie, & Ream, 2017). Although addressing health literacy has been nationally recognized as a healthcare imperative, little is known about nurses’ experiences and comfort with health literacy assessment and providing health literacy support.