Treatment burden and health literacy among patients referred to a vascular access clinic: a cross-sectional study

Background Treatment burden, defined as ‘the work of being a patient’, can have implications on clinical outcomes and quality of life. Delivering minimally burdensome care requires recognition of the distribution of treatment burden in specific patient populations, and consideration of its key drivers whilst designing healthcare services. Methods A prospective, cross-sectional study was performed to assess treatment burden among patients attending a regional vascular access surgery clinic over a 2-year period. Health literacy was synchronously measured to assess patients’ ability to process written information in the clinic. Results A total of 563 patients were included (median age 64 years; 57% male), of whom 263 were receiving kidney replacement therapy (KRT). One in five patients (20%; 113/563) reported treatment burden levels indicative of being at risk of becoming overwhelmed by their care. Higher treatment burden was associated with dialysis dependence and greater socioeconomic deprivation. On multivariate analysis, poor health literacy was independently associated with unsustainable treatment burden (OR 3.78, p < 0.001). Conclusions High treatment burden is prevalent among vascular access patients, particularly those with limited health literacy. Interventions that deliver patient-centred information in ways that do not depend on high literacy levels may help reduce treatment burden and support shared decision-making in this setting.