Initial implementation of a cancer health literacy questionnaire among owners of pet dogs and cats attending a primary veterinary healthcare service: Part I. Cross-sectional evaluation of the cancer health literacy of the study population

Background Health literacy (HL) reflects the capacity of individuals to obtain, process, and understand healthcare-related information, and to apply that information in making preventative, diagnostic, and treatment decisions. Cancer health literacy (CHL) is a contextually specific subset of HL that is essential for informed and shared decision-making in cancer care, and significantly impacts cancer-related outcomes in people. Limited CHL has been associated with reduced screening uptake, delayed diagnosis, poorer treatment adherence, and worse survival outcomes in human oncology. The authors postulate that CHL has comparable implications in a veterinary oncologic setting. This study documents the initial deployment of a questionnaire, specifically developed to assess CHL in veterinary clientele, and examines associations between respondent demographic characteristics and CHL scores. Methods A questionnaire, adapted from published CHL instruments developed for human medicine and modified for relevance to veterinary oncology and pet owners as surrogate decision-makers, was disseminated online to owners of dogs and cats attending the routine healthcare service at the Kansas State University Veterinary Health Center, between January 2015 and December 2020. Univariable associations between demographic variables and CHL scores were evaluated, followed by multivariable regression modelling to estimate associations between demographic characteristics and CHL scores. Results Of 13,446 questionnaires disseminated, 1,773 responses were received (response rate 13%), and 1,548 met the inclusion criteria. Mean CHL scores among respondents was 26.69 out of 30 (SD 2.4). Age, ethnicity, level of education, and a reported cancer diagnosis in a family member were significantly associated with mean CHL scores on multivariable analysis. Conclusions The study’s findings indicate associations with CHL scores, however, these should be interpreted with caution as the instrument has not yet undergone full psychometric validation. Consistent with evidence from human medicine, the results support the premise that demographic characteristics influence the CHL of pet owners. These findings underscore the importance of considering CHL when communicating with pet owners about cancer, with the aim of improving client understanding, clinical communication, and patient outcomes. Further research is warranted to better characterise the factors influencing effective cancer communication in veterinary settings, and to develop targeted strategies to address deficiencies, thereby improving client satisfaction and patient outcomes.