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Accountability on Health Literacy Levels to Remove Barriers to Health Care

There are two kinds of health literacy: personal health literacy and organizational health literacy. Personal health literacy describes the extent to which people have the capacity to locate, comprehend, and apply information and/or services that they have obtained to make informed health decisions and actions for themselves and others. Organizational health literacy is the extent to which organizations and associations equip individuals with what is necessary to draw conclusions and inferences that enhance their understanding and enable them to make informed health decisions and act for themselves and others.

Why is Health Literacy Important?

Health literacy is instrumental in influencing health disparities because it can serve as an essential barrier or bridge to comprehension of health education material. An impactful determinant of health, a person’s health literacy is more likely to accurately predict their behaviors when compared with economic status, age, or ethnic background. Health literacy also has a substantial effect on an individual’s health: those who lack health literacy are twice as likely to be hospitalized as those who possess satisfactory levels of health literacy. The most common cause for this could be: misinterpretation of information or incorrect dosage of self-administered medication or treatments. 

Those who lack health literacy may be ashamed and/or hesitant to open up about this issue with their healthcare providers for fear of judgment, and this may hinder their trust in the healthcare industry. This in turn may be pernicious towards their overall well-being.

How Can We Account for This When Developing Educational Materials?

There are an abundance of ways to make accommodations in health resources in order to account for differences in health literacy.

  • Use Plain Language
      • Avoid technical slang or jargon
        • If technical terms are used, be sure to define them in lay language and contextualize it so that the intended audience understands how and when it is utilized.
      • If the health resource is an article, include a plain language summary (this is something that the database Cochrane practices), a glossary of terms and words with phonetic pronunciation guides, and at least one example of how the term or phrase is used.
  • Be Aware of Appropriate Phrasing and Preferred Communication
      • Be sure to provide materials in the languages that are most often spoken in your area, and to interact with reliable translators to verify that the facts are coming across correctly and fully in all languages.
        • Brochures, forms, and other materials at health education events can be available in multiple languages
        • It is important to be aware of perception of words used in verbal and written communication
          • For instance, avoid the qualifier “disorders” when discussing mental health or the term “co-morbidities”, since they carry negative connotations. Instead, opt for terms such as “mental health conditions”, and “co-occurrences”. 
        • Identity-first vs person-first
          • Identity-first language puts a person’s condition before the person, and person-first language puts the person before their condition.
            • Preferences depend on the community, so it is important to consult a variety of sources and be receptive to your audience(s) and their input.
  • Visual Supplements for Written Materials 
    • Infographics
      • Can provide helpful imagery to highlight main ideas of the research
      • Assists people who may have trouble imagining what the text is conveying
    • Text, Font, and Contrast
      • Large text can be helpful for people with visual impairments
      • Fonts should be clear and legible
      • Colors, hues, or both for background and text should contrast in a way that does not obscure the information

Just as zip code is a salient social determinant of health, health literacy serves as an important indicator of potential health behaviors and outcomes. Being able to consume, understand, and disseminate health information will help people and those they care about immensely in that the decisions made and actions taken will be more robustly supported and informed. 

Reach out to us at [email protected] if you would like to collaborate and create accessible health materials pertaining to colorectal cancer, prevention, or another related topic!

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo credit: Alexander Grey on Unsplash.

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Colorectal Cancer Advocates Celebrate Screening Policy Reforms

patient consultation

The new year brought news of two success stories in our fight to increase accessibility to colorectal cancer (CRC) screening. The first, is a change in private insurance coverage requirements for colonoscopies. The second is from Kentucky, where a pharmacy protocol was passed to allow at-home fecal tests to be taken care of like a regular prescription. More details below.

Coverage for Screening Colonoscopy Without Cost Sharing

A document jointly released by the Departments of Labor, Health and Human Services, and Treasury on January 10th 2022 categorically states that private insurance plans are required to cover a follow-up colonoscopy after a positive non-invasive stool-based test or a direct visualization screening test, without any cost-sharing with respect to the colonoscopy for the health plan beneficiary. This coverage requirement will go into effect on May 31, 2022, one year after the updated recommendation on CRC screening was issued by the US Preventive Services Task Force. 

The Affordable Care Act requires health insurers to fully cover preventive screening. However, colonoscopies done after a stool-based test (such as FIT, gFOBT, or MT-sDNA/sDNA-FIT) were considered diagnostic and were not covered in the same way as decennial colonoscopies. 

Medicare covers a follow-up colonoscopy after a positive stool-based screening test result. Medicaid coverage policies vary based on the state.

Kentucky: Easy Access to Stool-Based Testing

On September 28, 2021, a new pharmacy protocol passed in the state of Kentucky will allow fecal immunochemical test (FIT) or stool DNA test (sDNA-FIT) to be taken care of at the pharmacy like a flu shot or regular prescription.

With the screening age for average-risk adults lowered to 45 years, it is important to eliminate the barriers for those who actually want and need screening. As we have seen over the last couple of years though, the COVID-19 pandemic has prevented many from getting the care that they need, including preventive care services. This bill has truly come at the right time. 

“Kentucky is the first state in the nation to have this type of protocol passed, and why not here?” said Dr. Whitney Jones, founder of the Colon Cancer Prevention Project, which is based out of Kentucky. “Colorectal cancer is treatable and preventable when caught early, and this new protocol will allow the general population more avenues to get screened on time.”

 

Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

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mRNA-Based Vaccine to Treat Colorectal Cancer and Prevent Relapse May Be Here Soon

Immunotherapy aids your immune system to fight off cancer. There are five types of immunotherapy: treatment vaccines, immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, and immune system modulators. While there have been no treatment vaccines approved for colorectal cancer (CRC) yet, BioNTech’s mRNA-based treatment vaccine has recently reached phase 2 clinical trials for CRC. The vaccine, individualized to each patient, is being developed as a treatment for CRC as well as to prevent relapse in those who have undergone CRC surgery. 

How Does Immunotherapy Work?

The immune system is built to detect and destroy abnormal/mutated cells. Tumor-infiltrating lymphocytes are often found around tumors and they are an indication that the immune system is working to eliminate the tumor. Cancer cells typically undergo genetic changes that allow them to escape the immune system—they often have proteins on their surface that inactivate immune cells, and they can even change cells surrounding them to interfere with the immune system. Therefore, a therapy that can train the immune system to identify and destroy cancer cells capable of defying the immune system is important.

Cancer Treatment Vaccines

Cancer treatment vaccines are designed for people who already have cancer, and trains their body’s immune system to find well-hidden cancer cells. These vaccines can be made in three different ways. 

  1. From the patient’s own cancer cells to cause an immune response against features that are unique to their cancer.
  2. From tumor-associated antigens that are found on cancer cells. These are made for cancer subtypes.
  3. From dendritic cells, which are a type of immune cell that respond to an antigen on tumor cells. This type of a vaccine is already being used for treating prostate cancer.

Matias Riihimäki et al. in their 2016 epidemiologic study published in Scientific Reports found that up to 18% of all CRC patients have recurrence and up to 25% have metastasis. A treatment vaccine would be able to help prevent recurrence and help patients with metastasis suppress small tumors that are often difficult to remove surgically.

BioNTech Chief Medical Officer and Co-founder Özlem Türeci, M.D., noted in a press release, “This trial is an important milestone in our efforts to bringing individualized immunotherapies to patients. Many cancers progress in such a way that the patient initially appears tumor-free after surgery, but after some time tumor foci that were initially invisible grow and form metastases. In this clinical trial in patients with colorectal cancer, we aim to identify high-risk patients with a blood test and investigate whether an individualized mRNA vaccine can prevent such relapses.”

Gargi Patel is a Colon Cancer Prevention Intern at the Colon Cancer Foundation.

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Dietary Mindfulness Can Reduce the Risk of Colorectal Cancer

A recently conducted systematic electronic search investigated keywords relating to colorectal cancer (CRC) and nutrition to define the association between diet and CRC. We summarize their findings here. 

What Can Change in My Dietary Habits?

According to the World Cancer Research Fund and American Institute of Cancer Research, 50% of CRC cases can be prevented by dietary and lifestyle modifications. While previous research studies concluded that high-fat and high-calorie diets had a carcinogenic effect, new research is showing that there is a specific role for nutrients such as fiber, vitamins, and minerals on intestinal metabolism. Consuming whole grains, dietary fiber, and dairy products decreases the risk of CRC, while consuming red and processed meats and fats increases the risk of CRC. Dietary interventions have increasingly been used over the past decade to reduce the occurrence and progression of CRC.

While there are some dietary habits that can reduce the risk of CRC, others can increase that risk. High-risk diets include those with red and processed meats, and diets made up of high fats and high carbohydrates. 

  • Processed meats are categorized as Group 1, meaning they are carcinogenic 
  • Red meats are categorized as Group 2A, meaning they are most likely to be carcinogenic 

Growth hormones in red and processed meats may be responsible for their carcinogenic effects. It is recommended that individuals limit the intake of red meats to 12-18 oz each day, and processed meats should be completely avoided. Many components of our diet may help prevent CRC: dietary fiber intake, for example, is inversely related to CRC development. Vitamins and minerals also play an important role in CRC prevention. 

  • Vitamins E and C have been shown to have a direct tumor suppressing effect on CRC 
  • Vitamin D has been shown to reduce the risk of developing CRC 
  • Calcium and selenium have also been shown to have an inverse effect on CRC

However, more research is needed to fully understand the role that fiber, vitamins, calcium, and selenium play in CRC development. 

There has also been significant interest in the role of gut microbiota (the bacteria in our gut) on CRC development. Research findings so far indicate that the microbiome and microbial metabolite health is pivotal to the prevention of several diseases such as CRC. The Mediterranean diet has positive effects on protecting individuals against CRC. Thus, nutritional therapies that are based on epigenetically active nutrients are likely to represent a good research direction.

In summary, dietary factors have a strong influence on CRC development. Consuming whole grains, dietary fiber, and dairy products can reduce the risk of CRC. Evidence also points to a role for vitamins in preventing CRC development. Ultimately, it is important to remember that future dietary recommendations will need to consider each person individually—looking at their cultural identities, risk factors, and the interaction between nutrients and the microbiota.

 

Abigail Parker is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Hospice Versus Palliative Care: Is There a Difference?

The month of November is designated as National Hospice and Palliative Care Month. While the terms are often used interchangeably, it is important for patients and their caregivers to understand the difference and realize the value of these services in the care journey.

Palliative care is offered to those suffering from serious illnesses such as cancer, stroke, or heart failure, with a focus on providing relief from the symptoms and stress because of the illness. Palliative support can be integrated into the care plan of both life-threatening as well as curable conditions and can be offered during active treatment. It is supportive care that can be offered to young and old patients, early-stage and advanced-stage patients. 

Hospice is specialized palliative care for people who are at the end of their life who may have less than 6 months of life expectancy. Hospice is focused on patient care and comfort while maintaining a decent quality of life close to the end. It is designed for when a serious health condition is not curable or when a patient chooses to not undergo certain treatments. The hospice care team does not attempt to slow disease progression. Rather, the sole focus is to manage symptoms so that the person’s last days are spent with dignity. Hospice care can be provided at home, in a hospital, or at an extended-care facility. 

 

Patient Perceptions of Hospice and Palliative Care 

A 2014 study published in British Medical Journal, which looked at 594 text responses of patients documenting their experience with palliative care, found that the emotional experience of care was the most significant and the most important to patients. A majority of patients said the emotional care they received for themselves and their families allowed them to cope with the newfound challenges with their illness. Another study that evaluated patient perceptions of palliative care quality in hospice inpatient care, daycare, and nursing homes found that “honesty”, “atmosphere”, and “respect and empathy” were the most important aspects of hospice care that they appreciated.

Insurance Coverage for Hospice and Palliative Care

Whether insurance covers hospice and palliative care, or how much is covered, depends on the insurance plan. Most insurance plans cover palliative care, but coverage may vary. It’s best to speak with your insurance plan for details. 

Most private insurance plans cover hospice care. Medicare and Medicaid provide complete coverage for hospice services. Medicare-certified hospice care is usually provided at home. Details on Medicare-covered hospice care can be found here and Medicaid coverage information is available here. 

 

Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

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