Patient/family education is a cornerstone of palliative care. The ability to comprehend information from medication labels, appointment slips, etc. is often taken for granted.
Health literacy - the ability to read, understand and act on basic health information - is limited and the prevalence is highest among underserved minorities, those with limited education, and the elderly.
Guilt and shame are common in those with poor literacy skills and may develop strategies to mask their deficiencies.

How to help patients.
Expect literacy problems when patients:
• Do not look at written materials
• Offer excuses when asked to read written materials
• Identify medications by color/shape rather than name
• Take medications incorrectly
• Have difficulty keeping appointments or filling out forms incorrectly or incompletely.

Check their deficits
Although patients with limited literacy skills are masters in hiding their deficit, they are often honest to health care professionals if the issue is directly addressed: “Is there anything that would make it hard for you to learn today?”, “Do you have any trouble seeing, or hearing, or reading?”

Manage the situation
• Written materials. Use materials with large print and simple language. Figures can improve comprehension and memory of instructions.
• Verbal communication. Plan to spend extra time; slow down your rate of speech, use simple, common words – avoid medical jargon - and short sentences. When possible, limit information to a maximum of three key items.
• Medication regimens. Make simpler regimens; reduce the number of medications, the number of pills, and the frequency of administration.

Assure comprehension
Explain instructions to a patient and have them teach them back to you, repeating until they demonstrated satisfactory understanding. Use open-ended phrasing such as “Please explain to me how you’re going to take this medication?” Prompt questions using an open-ended format such as “What questions do you have?”
Develop a follow-up plan to assess literacy of key caregivers may need to be assessed: frequent visits and telephone calls

See reference for more information.

Adapted from Reisfield GM and Wilson GR. Health literacy in palliative medicine. Palliative Care Network of Wisconsin. Fast facts and concepts #153. Internet. Accessed on June 24, 2019.