EP157 - Health Literacy, Patient Understanding, and Trust in Colorectal Surgery

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Purpose/Background: Health literacy affects how one understands health information and trust can influence one’s willingness to undergo recommended treatment interventions. These factors have implications for important surgical outcomes like hospital readmissions and post-operative complications. This study aims to determine health literacy, patient-reported understanding, and trust levels of patients receiving colorectal surgical care in an academic health system.

Methods/Interventions: This cross-sectional study was conducted within a single academic health system’s colon and rectal surgery department. Patients with preoperative clinic visits and no prior operations with the consultant surgeon were eligible to participate. After the clinical encounter, consented participants were verbally administered the BRIEF Health Literacy Screening Tool, a patient-reported understanding survey, and the Wake Forest Trust Scale. BRIEF scores of 4-12 indicated limited health literacy, 13-16 marginal, and 17-20 adequate. Survey responses were linked to demographic and medical information and deidentified. Descriptive statistics were performed, followed by logistic mixed models assessing relationships between patient factors, health literacy, and understanding. Mixed model linear regressions assessed relationships between patient factors and trust.

Results/Outcomes: Two hundred participants enrolled in the study. The average age was 54.4 years, 55.5% identified as female, and 74.5% identified as non-Hispanic White. The majority (62%) earned a college degree or higher. Participants with at least some college education were 1.92 times more likely to have adequate health literacy than participants who completed high school or less (p < 0.001). Participants with cancer were 0.34 times less likely to have adequate health literacy compared to participants with other colorectal diagnoses. Participants with diverticular disease were 0.41
times less likely to have complete understanding of their surgical care compared to participants with other diagnoses (p < 0.001). Participants with scheduled operations were over two times more trusting of their surgeons than participants without a planned procedure (inpatient p=0.01, outpatient p=0.0035). Participants with adequate health literacy had higher understanding scores and participants reporting complete understanding of their surgical care had higher trust scores (p=0.05).

Conclusion/Discussion: Patient, disease, and surgical planning factors have variable relationships with health literacy, understanding, and trust. Education beyond high school has a positive relationship to health literacy, understanding, and trust. Diseases with comprehensive and/or variable management plans pose challenges to patient understanding. Follow-ups prior to surgery and scheduled operations improve patient trust of colorectal surgeons. Routine health literacy screening in surgery clinics can identify patients at risk for lower understanding of complex surgical care. Multimodal communication tools and pre-operative follow-up visits may assist surgeons in delivering understandable surgical information to their patients and developing more trusting relationships.