Variation in coordination of care reported by breast cancer patients according to health literacy
Health literacy is the ability to perform basic reading and numerical tasks to function in the healthcare environment. The purpose of this study is to describe how health literacy is related to perceived coordination of care reported by breast cancer patients.
Data were retrieved from the Patient-Centered Outcomes Research Institute-sponsored “Share Thoughts on Breast Cancer” Study including demographic factors, perceived care coordination and responsiveness of care, and self-reported health literacy obtained from a mailed survey completed by 62% of eligible breast cancer survivors (N = 1221). Multivariable analysis of variance was used to characterize the association between presence of a single healthcare professional that coordinated care (“care coordinator”) and perceived care coordination, stratified by health literacy level.
Health literacy was classified as low in 24% of patients, medium in 34%, and high in 42%. Women with high health literacy scores were more likely to report non-Hispanic white race/ethnicity, private insurance, higher education and income, and fewer comorbidities (all p < 0.001). The presence of a care coordinator was associated with 17.1% higher perceived care coordination scores among women with low health literacy when compared to those without a care coordinator, whereas a coordinator modestly improved perceived care coordination among breast cancer survivors with medium (6.9%) and high (6.2%) health literacy.
The use of a single designated care coordinator may have a strong influence on care coordination in patients with lower levels of health literacy.
KeywordsContinuity of patient care Quality of health care Patient-centered care Health literacy Breast neoplasms Patient navigation
The authors would like to thank Julie McGregor, Amy Godecker, Kathy Peck, and Sarah Esmond for their assistance with data collection and study conduct. The authors would like to thank the following: the Share Thoughts on Breast Cancer patient advocates who helped develop the study questionnaire including Cheryl Jernigan and Jody Rock; the study site coordinators and project managers who conducted the study mailings including Teresa Bosler, Michele Coady, Mack Dressler, Sarah Esmond, Bret Gardner, Amy Godecker, Brian Gryzlak, Julie McGregor, Deb Multerer, Char Napurski, Kathy Peck, Nick Rudzianski, Sabrina Uppal, Xiao Zhang, and Brittany Zschoche; investigators overseeing data collection including Drs. Anne Berger, Anne Blaes, Elizabeth Chrischilles, Lindsay Cowell, Barbara Haley, Jennifer Klemp, Ingrid Lizarraga, Joan Neuner, Adedayo Onitilo, Amalie Ramirez, and Priyanka Sharma; and the Greater Plains Collaborative informatics team who integrated tumor registry data and selected the study samples including Bhargav Adagarla, Daniel Connolly, Tamara McMahon, Glenn Bushee, Supreet Kathpalia, Jim McClay, Eneida Mendonca, Tom Mish, Susan Morrison, Phillip Reeder, Nicholas Smith, and Laurel Verhagen.
This project was supported by PCORI contract CDRN-1306-04631 and NIH grants UL1TR000427 for the University of Wisconsin Institute of Clinical and Translational Research, P30CA014520 for the University of Wisconsin Carbone Cancer Center, and P30 CA086862 for the Holden Comprehensive Cancer Center. Funding for Dr. Mora-Pinzon was provided by the UW School of Medicine and Public Health through the Wisconsin Partnership Program.
Compliance with ethical standards
The protocol for this cross-sectional survey study was approved by the University of Iowa Institutional Review Board (IRB).
Conflict of interest
The authors declare that they have no conflict of interest.
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