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Health literacy, information provision and satisfaction in advanced cancer consultations: two observational studies using level of education as a proxy
  1. Liesbeth M van Vliet1,2,
  2. Janneke Noordman3,
  3. Marit Mijnlieff3,
  4. Ruud Roodbeen3,4,
  5. Gudule Boland5 and
  6. Sandra van Dulmen3,6
  1. 1 Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
  2. 2 Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
  3. 3 Department of Communication, NIVEL, Utrecht, The Netherlands
  4. 4 Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
  5. 5 Pharos, Dutch Center of Expertise on Health Disparities, Utrecht, The Netherlands
  6. 6 Institute for Healh Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Liesbeth M van Vliet, Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands; l.m.van.vliet{at}


Objectives Patients with low health literacy (LHL) might feel less informed and satisfied with provided information than patients with high health literacy (HHL). In the setting of advanced cancer, we explored whether LHL patients, compared with HHL patients are: (1) often less informed, and (2) less satisfied with clinicians’ communication (a) in general and (b) following information provision specifically.

Methods Data from two observational studies using recorded consultations were combined. Clinicians’ provided information and patients’ health literacy level—defined by educational levels—and satisfaction were measured. Χ2 tests and regression (moderation) analyses assessed the relation between health literacy and information provision, and between information provision and satisfaction, meanwhile exploring moderating influences of health literacy.

Results Of 61 included patients, 25 (41%) had LHL. LHL and HHL patients were equally seldom informed about the disease’s incurability (36% vs 42%, p=0.66). LHL patients were more often informed about the option of not pursuing anticancer therapy than HHL patients (28% vs 8%, p=0.04). LHL patients were more satisfied with clinicians’ communication than HHL patients (M=9.3 vs M=8.5, p=0.03), especially when the option of no anticancer treatment was discussed (p=0.04). Discussing the disease’s incurability did not influence satisfaction levels (p=0.58) for LHL and HHL patients.

Conclusions LHL patients were not less informed, yet more satisfied than HHL patients. Both groups were equally seldom informed about the disease’s incurability. No anticancer therapy was mostly discussed with LHL patients who were more satisfied following this information. Clinicians should be encouraged to inform all patients about the disease status and (non)treatment options, while not overlooking empathic support.

  • communication
  • cancer

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  • Contributors LMvV—funding acquisition, planning, conduct, analysing, writing and guarantor. JN—planning, conduct, analysing, rewriting and guarantor. MM—analysing and rewriting. RR—planning, conduct, analysing and rewriting. GB—funding acquisition, planning, analysing interpretation and rewriting. SvD—funding acquisition, planning, analysing interpretation and rewriting.

  • Funding Study 1 was funded by the Dutch Cancer Society via a personal grant awarded to LMvV (YIG, 10392) and by a grant from the Netherlands Institute for Advanced Study in the Humanities and Social Sciences (NIAS-KNAW) awarded to LMvV. Study 2 was funded by a grant from the Netherlands Organisation for Health Research and Development, Palliative Care Program (ZonMw, Palliantie: 844001403).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.