In an initial meeting with a patient, it can be difficult for oncologists to discern how much the patient knows about their cancer. And the same is true of that patient’s family, who may be present at the appointment.
Professor of Epidemiology and Biostatistics Levent Dumenci and his co-investigators created a cancer health literacy test to help oncologists and other healthcare providers understand their patients’ level of cancer health literacy. Now, after conducting further research, Dumenci and his colleagues have found that the same test can be used to successfully gauge the cancer health literacy of an individual without cancer.
The findings, published last year, administered the cancer health literacy test on a hand-held touch-screen device to 512 individuals from various backgrounds. The research team, which included Laura A. Siminoff, dean of the College of Public Health, found that the 30-question test (known as CHLT-30) could predict an individual’s understanding of cancer with a high degree of reliability, regardless of demographic differences such as race, gender and education level. “We thought the CHLT-30 could be used on populations without cancer,” said Dumenci. “What we found was those with cancer would score higher on the scale than people without cancer, due to exposure to language around cancer during treatment after a cancer diagnosis.”
The Cancer Health Literacy Test was created over a five-year period, and results about the test (based on individuals with cancer) were published in 2014. The test comprises both multiple choice and true and false questions, such as “The normal range for hemoglobin for a male is 13.3-17.2 g/dL. Joe’s hemoglobin Is 9.7 g/dL. Is Joe within the normal range?” and “Adjuvant therapy is cancer treatment generally given after a tumor is removed. Neoadjuvant therapy is cancer treatment generally given to shrink a tumor before surgery. Mr. Davis has had his tumor surgically removed. After his surgery, he will get chemotherapy. The chemotherapy is (a) Neoadjuvant; (b) Adjuvant.”
The Cancer Health Literacy Test also comes in a stripped-down six-question version (not included in the April study) that helps oncologists identify patients with limited cancer health literacy more quickly. Responses to the six questions, taken from the 30-question test, determines the likelihood that a given patient has either limited or adequate literacy. “No matter how good a clinician you are, how good an analysis you can make, if the patient doesn’t take medications, doesn’t understand information, and doesn’t show up to appointment, that has a major impact on health outcomes,” says Dumenci. “Understanding patient cancer health literacy levels can help make sure efforts and expenses aren’t in vain.”
The cancer health literacy test is available for free to providers and researchers, but users are restricted from drawing profit from the test. Since its introduction in 2014, the test has been translated into Spanish, and Dumenci and his colleagues are currently overseeing the translation of the test into Mandarin Chinese. They hope to develop a mobile application that administers the test in the future.
— Tara W. Merrigan