2025 Proffered Presentations
S362: HEALTH LITERACY IN THE ANTERIOR SKULL BASE POPULATION - DEMOGRAPHIC, SURGICAL, AND SYMPTOM-RELATED FACTORS
Jakob L Fischer, MD; Cheikh A Mballo, MA; Marvin Bergsneider, MD; Won Kim, MD; Jeffrey D Suh, MD; Daniel M Beswick, MD; Jivianne T Lee, MD; Marilene B Wang, MD; University of California, Los Angeles (UCLA)
Background: Health literacy describes a patient’s ability to understand and communicate healthcare-related information in order to make informed decisions about their care. Previous studies have found that patients with inadequate health literacy are more likely to experience poor outcomes with increased morbidity, mortality, and hospitalization rates. Prior studies have demonstrated that patients with sinonasal issues have disease-specific decreases in their quality of life but there has been limited literature examining the role of health literacy in patients with anterior skull base lesions and the impact of health literacy on their outcomes.
Methods: Patients presenting to a tertiary academic practice between April 2024 and July 2024 for evaluation of an anterior skull-base neoplasm were provided a series of three questionnaires: the 22-item Sinonasal Outcome Test (SNOT-22), a 8-question medication adherence survey (8-MAS), and a 4-question brief health literacy survey (BHLS). The BHLS is a validated survey to gauge health literacy with individual items scored on a Likert scale from 1-5(Figure 1). Patients were considered deficient in any individual component of the BHLS if they responded with a score of ≤3 points and were considered globally inadequate health literate if their composite score was ≤15 points. Demographic data, imaging characteristics, and surgical data were reviewed.
Results: 29 patients (18 male[62.1%]; mean [SD] age (46[18.7] years) were included in this actively recruiting study. Seven(24.1%) patients were inadequately literate on at least one component of the BHLS. Patients expressing inadequate health literacy were most likely to indicate a lack of confidence in filling out medical forms by themselves(5,71.4%). There was no association between self-reported health literacy and age at initial encounter, gender, race, ethnicity, primary language, marital status, or education level(p>0.05). At the time of this study, 26 patients(90%) had undergone endoscopic trans-nasal trans-sphenoidal surgery for their skull-base neoplasm. There was no difference in length of hospitalization(p=0.18) or post-operative complication rates(p=0.86) between populations. Patients with inadequate health literacy were noted to have substantially greater tumor volume(average±SD;2282.8±2570.8cc) than their health literate counterparts (1019.1±1032.8cc)(p= 0.04). Only 16.7%(n=5) inadequately health literate patients indicated remembering to take their medications yesterday on their 8-MAS, and 50%(n=3) indicated having difficulty remembering to take their medications. In contrast, 52.6%(n=10) patients with adequate health literacy remembered to take their medications the previous day and 15.8%(n=3) reported having difficulty remembering to take their medications; p=0.12 and p=0.09, respectively. There were no differences in baseline SNOT-22 scores among new patients having not yet undergone TNTS when comparing inadequate health literacy (n=3) to adequately health literate patients (n=11)(p=0.14).
Conclusion: Many patients with anterior skull base lesions self-report inadequate health literacy in at least one aspect of their medical care. This has important implications in the care of patients and their ability to participate effectively in their medical care. Patients with poorer health literacy present with larger tumors, potentially indicating a poorer recognition of symptoms and treatment delay related to these lesions. Larger patient populations are necessary to determine other potential implications of health literacy on patient care.
Figure 1: Brief Health Literacy Survey
