Focused Education Increases Hepatocellular Cancer Screening in Patients with Cirrhosis Regardless of Functional Health Literacy

• Published in: Digestive diseases and sciences Vol. 66; no. 8; pp. 2603 - 2609
• Main Authors: Shaw, Jawaid, Patidar, Kavish R., Reuter, Bradley, Hajezifar, Navid, Dharel, Narayan, Wade, James B., Bajaj, Jasmohan S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2021; Springer; Springer Nature B.V
• Subjects: Biochemistry; Cancer; Cancer patients; Diagnosis; Gastroenterology; Health education; Health literacy; Hepatology; Intervention; Liver cancer; Liver cirrhosis; Medical colleges; Medical screening; Medicine; Medicine & Public Health; Oncology; Original Article; Patient compliance; Patient education; Transplant Surgery; Health literacy; Screening; Education; Liver cirrhosis; S-TOFHLA; Hepatocellular cancer
• DOI: 10.1007/s10620-020-06583-x
• EISSN: 1573-2568
• ISSN: 0163-2116

Background
Health education interventions are successful in modifying lifestyle. Functional health literacy (FHL) can determine patient adherence to clinic visits and procedures and may adversely impact the success of these interventions.
Aims
We sought to evaluate the hypothesis that a health education intervention would improve compliance with hepatocellular cancer (HCC) screening and that poor FHL would reduce such compliance.
Methods
We assessed FHL using a short version test of functional health literacy in adults (STOFHLA). Cirrhotic patients free of HCC were prospectively enrolled from clinics and provided an educational intervention consisting of focused physician-led discussion regarding cirrhosis and HCC, along with written material on these topics for the subject to review at home. Patients were subsequently followed for 6 months (prospective time period), and the same cohort’s clinic/HCC screening behavior between 6 and 12 months prior to the educational intervention (retrospective time period) was compared.
Results
In total, 104 cirrhotic patients (age 60.01 ± 8.58 years, 80% men, MELD 12.70 ± 5.76) were included. Of these, 89 (85.57%) of patients had educational level 12th grade and higher. There were 76% (
n
 = 79) with adequate, while 24% (
n
 = 25) had inadequate/marginal FHL on S-TOHFLA. The number of HCC-related imaging increased from 59 (56.7%) to 86 (82.6%,
p
 < 0.0001) post-education in the prospective compared to prior time period which was similar regardless of FHL.
Conclusions
While the educational intervention was successful in improving compliance with HCC screenings, FHL status did not impact the power of this intervention. Hence, the combination of specific verbal information, along with targeted written material, improved compliance with clinic visits and liver imaging for HCC.