Oncology Nurses' Role in Improving Health Literacy

By Fatemeh Youssefi PhD, RN, OCN® - Last Updated: September 1, 2022

Oncology nurses can help patients increase their health literacy, which will empower them to make shared decisions with their health care team. With improved communication among the care team, patients can participate in shared decision-making, becoming active members when making life and death decisions.

What Is Health Literacy?

Although the general meaning of “literacy” is the ability to read or write, the definition of “health literacy” goes beyond this. Healthy People 2030 defines it as one’s “ability to use health information rather than just understand it.”

Furthermore, health literacy includes the ability to:

  • Obtain, process, and understand basic health information
  • Make well-informed decisions

This definition is for personal health literacy versus organizational health literacy. Organizational health literacy is the responsibility of an organization to create policies, practices, and systems to help patients navigate, use, find, and understand information.

Health literacy is beyond basic reading and writing skills. It involves understanding the basic information of everyday instructions to be an active participant in health care. Patients need to process the information to understand and comprehend the plan of care:

  • How and when to take medications
  • How and when to report side effects
  • Possible drug–drug or drug–food interactions
  • Making follow-up appointments

Along with the challenges of the care plan, many patients may need to locate financial resources or learn how to communicate electronically with their health team.

How Does Low Health Literacy Affect Patient Outcomes?

The Centers for Disease Control and Prevention (CDC) reports that patients with low health literacy will have increased emergency department visits, prolonged hospitalizations, higher frequencies of not following health plans, and higher death rates. According to the Association of Community Cancer Centers, improvements in health literacy can improve upon the following:

  • Cancer prevention due to healthier lifestyle choices and cancer screening
  • Cancer survivor engagement, which may enhance emotional well-being
  • Patient-centered, personalized care
  • Accreditation standards and quality care models

Mental states such as anxiety or depression can influence health literacy, regardless of the education level. Even patients with higher education or a career in health care can have low health literacy due to the emotional stress of a cancer diagnosis or recurrence.

What Is the Nurses’ Role in Assessing Health Literacy?

Nurses must have effective communication and assess patient comprehension as limited health literacy is linked to worse outcomes. In oncology, the interdisciplinary team is more than just nurses and providers. The team includes dietitians, social workers, pharmacists, and other members who engage and interact with the patient. In addition, their team may involve other specialists within oncology, such as radiation oncology or outside of oncology, such as cardiology.

Healthcare professionals should avoid “blaming” the individual when they are unable to process the information. Often, patients’ perceptions are different, and their understanding of instructions is different. Since each team member approaches and communicates with patients differently, oncology nurses must assess patient understanding of all the information from various disciplines.

What Tools Can Nurses Use to Help Improve Patients’ Health Literacy?

Below are examples of three tools that all oncology nurses can use regardless of their role or function–infusion nurse, clinic nurse, inpatient nurse, navigators.

  1. Sensory Aids. Be aware if patients require hearing aids or eyeglasses. Encourage patients to use them to hear and read the information. Look out for patients who have trouble hearing or seeing. Refer them to resources to help them obtain sensory aides if they do not have them. Remember if you are wearing a mask, many patients with hearing problems are reading lips.
  1. Make sure patient materials are written at a fifth to sixth grade level. Assess the need to provide education in the patient’s primary language. Explore if the patient needs an interpreter for information.
  1. Teach Back. After providing patients with information, ask them to repeat it back to you. This method gives you the opportunity to make sure patients understand the instructions and to clarify any misinformation.

As a society, when we improve patient health literacy, they can take an active role to make health decisions. Nurses can empower patients by assessing patient understanding of health information. Use tools and time to teach and encourage patients to be active participants in their care.



Health Literacy in Healthy People 2030

Improving Health Literacy

Patients With Low Health Literacy

Health Literacy