Health literacy is increasingly recognized as a critical factor affecting communication across the continuum of cancer care. We reviewed research on health literacy and examined its impact on cancer outcomes and communication. According to the National Adult Literacy Survey (NALS), considered the most accurate portrait of literacy in our society, about one in five American adults may lack the necessary literacy skills to function adequately in our society. As patients, such individuals are at a disadvantage in their capacity to obtain, process, and understand cancer information and services needed to make appropriate health care decisions. Patients with poor health literacy have a complex array of difficulties with written and oral communication that may limit their understanding of cancer screening and of symptoms of cancer, adversely affecting their stage at diagnosis. In addition, these barriers impair communication and discussion about risks and benefits of treatment options, and patient understanding of informed consent for routine procedures and clinical trials. More research is needed to identify successful methods for educating and communicating with patients who have limited health literacy. Based on our own experience, we offer practical communication aids that can help bridge the cancer communication gap.

Physicians' weight loss counseling had a significant effect on patients' understanding of and motivation for weight loss. However, physicians provided insufficient guidance on weight management strategies, possibly because of inadequate counseling skills and confidence.

Pharmaceutical management of HIV infection is complex, and proper adherence to antiretroviral regimens is contingent on active patient involvement in treatment. We examined the relationship between patient understanding of HIV and its treatment and health literacy. Structured interviews were conducted with 157 HIV-infected individuals receiving care at a community-based clinic in Shreveport, Louisiana, USA. In all, 48% of patients were reading below a 9th grade level. One-third of patients could not name their HIV medications and this was significantly related to low literacy (P < 0.01). Two-thirds of those reading below the 9th grade level did not know how to take their medications correctly (P < 0.05), and 75% did not know the meaning of a CD4 count or viral load (P < 0.001). Patients with low literacy skills were more likely to state that their physician was their sole source of HIV information (P < 0.005). Physicians may require training to appropriately convey health information to patients of low literacy.