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The role of health literacy in hospital utilization for head and neck cancer patients

Heath, Kailen (2021) The role of health literacy in hospital utilization for head and neck cancer patients. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background: Research to date has focused heavily on clinical factors associated with increased hospital utilization for head and neck cancer (HNC) patients. Studies in other chronic conditions have found associations between health literacy and hospital utilization, but there is little research about the association in the HNC population.
Purpose: This study aims to determine the rate of hospital utilization during radiation treatment and the 90 day follow-up period and assess whether health literacy plays a role in hospital utilization for HNC survivors.
Methods: This is a retrospective analysis of 95 survivors seen at the UPMC Head and Neck Cancer Survivorship Clinic. During the pre-radiation evaluation, health literacy was assessed using question 1 of the Brief Health Literacy Screen (BHLS) to evaluate confidence in filling out medical forms by oneself. Hospital utilization during radiation treatment and the 90 day follow-up period were the outcome variables of interest. Single-predictor regression models were run to assess which predictors met the criteria for inclusion in multivariable regression analysis. Multivariable analysis was performed using negative binomial regression or poisson regression to determine which predictors were associated with hospital utilization.
Results: Of the 95 survivors, 17 survivors (17.9%) had inadequate health literacy, which was more prevalent in those who did not undergo surgery, were current cigarette smokers and had laryngopharynx cancer. The rate of total hospital utilization during the entire study period is 46.3%, with 30.5% during treatment and 31.6% in the follow-up period. Health literacy was associated with total hospital utilization and ER visits alone during treatment. Additional factors related to the outcomes included concurrent chemoradiation, advanced cancer stage, neighborhood deprivation, feeding tube placement, race, and age in various multivariable models.
Conclusion: There was an association between health literacy and hospital utilization that requires additional research utilizing a prospective approach to further explore this phenomenon. Such research should use variables assessing broader domains of health literacy, social determinants of health, and patient outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Heath, Kailenkjh102@pitt.edukjh1020000-0002-5348-792X
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorNilsen, Marci Leemlf981@pitt.du
Committee MemberGallups,
Committee MemberSereika, Susan
Committee MemberClump, David
Date: 23 April 2021
Date Type: Publication
Defense Date: 31 March 2021
Approval Date: 23 April 2021
Submission Date: 23 April 2021
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 50
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: Head and Neck Cancer, Health Literacy, Hospital Utilization, Hospitalization, Radiation Therapy
Date Deposited: 23 Apr 2021 15:13
Last Modified: 23 Apr 2022 05:15


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