Many of the materials used to educate patients with breast cancer about chemotherapy require a higher reading level than that recommended by the National Institutes of Health, 7th or 8th grade. This study was published in the Journal of Cancer Education.

Although educational materials are considered to be a critically important component of treatment for women with breast cancer undergoing chemotherapy, patient comprehension of these materials is central to their usefulness. Furthermore, research on the experiences of these women as they relate to chemotherapy education has been limited.

Related Articles

The aims of this study were 2-fold: to evaluate the readability and format of 5 commonly used printed or online chemotherapy educational materials using several standardized assessment measures and to evaluate the perceptions of women with breast cancer regarding the usefulness of these materials.

Continue Reading

This study was conducted at the South Carolina Oncology Associates (SCOA) clinic where all patients with breast cancer were required to attend a nurse educator-led educational session prior to starting chemotherapy.

Criteria for study eligibility included age 18 years or older, a new breast cancer diagnosis, and the ability to speak English; patients with stage IV disease, a recurrence of breast cancer, or cognitive impairment were excluded from the study. 

Of the 110 patients meeting eligibility requirements, 55 were successfully contacted by telephone regarding study participation, and 46 patients agreed to participate in the study.

Demographic characteristics of the study population included a median age of 59 years, 50.0% were black, and 47.8% were white. Regarding highest level of education attained, all patients reported graduating from high school, with approximately 50% of patients having completed at least a 4-year college degree. In addition, the health literacy of this group was determined to be above a 9th-grade level.

All educational materials evaluated were determined to be superior in terms of content, although the literacy demands of the chemotherapy educational booklets from SCOA, Susan G. Komen, and were classified as being particularly high. For example, all 5 educational materials required at least a 9th-grade reading level, but a mean reading level of 12th- to 13th-grade was determined to be necessary to understand the chemotherapy pages on the website.

Another theme uncovered in this study was the dearth of illustrations to facilitate understanding, as well as the absence of culturally appropriate pictures or information.

With respect to these findings, the study authors suggested that nurse educators could consider supplementing educational materials with visual aids, and that inclusion of videos on websites providing education on chemotherapy may facilitate patient understanding. They further noted that “nurse educators need to evaluate the reading

level of the materials and patients’ level of health literacy skills to determine if any potential gaps could exist in learning.”

One of the study limitations mentioned by the authors was the use of assessment measures developed for printed materials only when online sources of chemotherapy education were evaluated.

Emergent themes following a qualitative analysis of patient perceptions of chemotherapy education included “finding control in learning,” “receiving unexpected support,” and “learning in unforeseen ways.” In particular, educational sessions were mentioned as facilitating opportunities to receive support from both nurse navigators and members of the community.


Parker PD, Heiney SP, Friedman DB, et al. The experience of chemotherapy teaching and readability of chemotherapy educational materials for women with breast cancer. J Cancer Educ. doi: 10.1007/s13187-019-01596-1

This article originally appeared on Oncology Nurse Advisor