World Cancer Day is an opportunity to reflect on health inequities in breast cancer care

World Cancer Day is an opportunity not only to reflect on advances in breast cancer treatment, but also to confront the persistent inequities that affect access to care, treatment experiences and outcomes. For clinicians, World Cancer Day is a reminder that addressing inequity is a clinical responsibility, and that working in partnership with patients can help to mitigate these disparities, particularly when it comes to health literacy.

One of the key concepts in providing great care is working in partnership with patients, making shared decisions about treatment options. However, whilst we may be pleased with ourselves about the volume of information we provide and the detailed letters we send to patients, how often do we stop to think about how well our patients understand this? How often do patients tell us they are overwhelmed by the amount of information given to them, which paralyses rather than promotes their decision making? Throw in the fear that accompanies a cancer diagnosis and it's no surprise that patients don’t take in or understand all the information we give them.

An individual’s inability to find, understand and use health information can worsen health inequities. Many factors may contribute to this – language, culture, general literacy, digital literacy, poverty, disability, social isolation.

Here is a shocking statistic: the average reading age for adults in the UK is between 9 and 11 years old, (2011 skills for life survey, www.gov.uk). 

Many of our patients will have difficulty understanding complex or unfamiliar information. It is imperative therefore that our written communication is accessible, avoiding jargon and complex medical terms. Macmillan and Breast Cancer Now supply patient information leaflets in easy read formats and multiple languages. Exact Science provides information on Oncotype in multiple languages on their website.

What simple things can we do to tackle this in our own practice?

• Provide ‘easy read’ versions of patient information leaflets
• Provide patient information leaflets in your patient's native language
• Ensure your verbal and written communication to patients is clear and simple to understand
• Can you offer patients alternatives to / along with written communication? (e.g. pictures, diagrams, voice notes) 
• ‘Chunk and check’: give information in bite size pieces and pause to check understanding and encourage questions
• Offer telephone follow up to check on understanding and encourage further questions

Useful resources:

• The Health Literacy Place
• Macmillan
• Breast Cancer Now