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SOCIAL DETERMINANTS SOCIAL DETERMINANTS
OF HEALTH OF HEALTH

have shown that less than half of women that had undergone treat- Kent Rohweder, MD is Associate Program Director for Di-
ment for UF understood what a fibroid was or had heard of uterine agnostic Radiology, Associate Professor of Radiology & Inter-
artery embolization (UAE) as a treatment option, and that the major- ventional Radiology and Associate Professor for Clinical
ity of women who had heard of UAE learned about it outside of their Emergency Room Radiology at UTHSC Long SOM. His clinical inter-
provider’s office. ests include interventional approaches for treatment of vascular, geni-
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These outcomes demonstrate an opportunity for better patient en- tourinary and hepatobiliary diseases; and trauma diagnosis and
gagement in shared decision-making during treatment selection. life-saving interventional radiology procedures.
It is important to remember that the average American adult reads
at about a 7th-8th grade reading level. Studies demonstrate that most References
of the available resources, including some ‘reliable’ resources, fail 1 . Rikard, R. V., Thompson, M. S., McKinney, J., & Beauchamp, A. (2016). Ex-
to provide educational material at the appropriate level, despite rec- amining health literacy disparities in the United States: a third look at the
National Assessment of Adult Literacy (NAAL). BMC public health, 16(1),
ommendations from the American Medical Association that patient
975. https://doi-org.uiwtx.idm.oclc.org/10.1186/s12889-016-3621-9
education material should be written at or below a sixth-grade read- 2 . Henry, C., Ekeroma, A., & Filoche, S. (2020). Barriers to seeking consultation
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ing level. Patient education material on the SIR website for UF was for abnormal uterine bleeding: systematic review of qualitative research. BMC
classified as ‘very difficult’ and ranged from 12th-17th grade reading women's health, 20(1), 123. https://doiorg.uiwtx.idm.oclc.org/
level. An evaluation of available online materials for uterine UF con- 10.1186/s12905-020-00986-8
3. Marsh, E. E., Al-Hendy, A., Kappus, D., Galitsky, A., Stewart, E. A., &
cluded that only 6.7% (3 of 45) websites met all JAMA benchmarks
Kerolous, M. (2018). Burden, Prevalence, and Treatment of Uterine Fibroids:
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to be classified as understandable reliable information. These studies
A Survey of U.S. Women. Journal of women's health (2002), 27(11), 1359–
point out the need for development of reliable and efficacious patient 1367. https://doi-org.uiwtx.idm.oclc.org/10.1089/jwh.2018.7076
education (online and in-print) and shared decision-making tools for 4 . Keij, S. M., van Duijn-Bakker, N., Stiggelbout, A. M., & Pieterse, A. H.
routine use during treatment consultation of women with uterine UF. (2020). What makes a patient ready for Shared Decision Making? A qualita-
Other ways to overcome health literacy as a barrier to shared deci- tive study. Patient education and counseling, S0738-3991(20)30462-6. Ad-
vance online publication. https://doi-org.uiwtx.idm.oclc.org/
sion-making in the treatment of UF include collaborative patient con-
10.1016/j.pec.2020.08.031
sultations between the gynecologist and an interventional radiologist. 5 . Zeuner, R., Frosch, D. L., Kuzemchak, M. D., & Politi, M. C. (2015). Physi-
This collaborative effort between interventional radiologists and gy- cians' perceptions of shared decision-making behaviours: a qualitative study
necologists has demonstrated benefits in facilitating patient decision- demonstrating the continued chasm between aspirations and clinical practice.
making by providing thorough exploration of all treatment options Health expectations: an international journal of public participation in health
care and health policy, 18(6), 2465–2476. https://doi-org.uiwtx.idm.oclc.
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from providers who will be performing the procedures. These discus-
org/10.1111/hex.12216
Health Literacy Improves Women’s Health Care sions are important to foster greater understanding of the advantages 6 . Society of Interventional Radiology - The fibroid fix: What women need to
and, more importantly, the limitations of treatment options.
know. (n.d.). Retrieved November 16, 2020, from https://www.sirweb.org/
Shared decision-making interventions have demonstrated signifi- patient-center/fibroid_fix2/fibroid-fix-report/
By Kalli R. Davis, OMS-II, Matthew D. Parker, MD, Ariana Lewis, MD, Kent Rohweder, MD cant benefits to disadvantaged patients, particularly those with limited 7 . Hansberry, D. R., Kraus, C., Agarwal, N., Baker, S. R., & Gonzales, S. F.
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health literacy. To provide optimal care for patients seeking treat- (2014). Health literacy in vascular and interventional radiology: a compara-
tive analysis of online patient education resources. Cardiovascular and inter-
Health literacy affects the quality of healthcare provided to an esti- Treatment for symptomatic UF is far from one-size fits all, and is ment for symptomatic fibroids, gynecologists and interventional ra-
ventional radiology, 37(4), 1034–1040. https://doi-org.uiwtx.idm.oclc.org/
mated 80 million Americans. People experiencing low health literacy influenced by patient’s personal preference, fibroid size, number, loca- diologists should work together to develop shared decision-making 10.1007/ s00270-013-0752-6
have difficulty obtaining and understanding information necessary to tion and numerous other factors. Physician communication of these tools for use during patient visits for management of symptomatic 8 . Murray, T. E., Mansoor, T., Bowden, D. J., O'Neill, D. C., & Lee, M. J. (2018).
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make decisions regarding their healthcare. Health illiteracy has been assessed factors can help guide patient participation in the shared de- uterine fibroids. Uterine Artery Embolization: An Analysis of Online Patient Information
recognized as a major barrier to obtaining care for symptoms associ- cision-making process. Quality and Readability with Historical Comparison. Academic radiology,
25(5), 619–625. https://doi-org.uiwtx.idm.oclc.org/10.1016/j.acra.
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ated with uterine fibroids (UF). With UF affecting 70-80% of pre- Patients may be overwhelmed by the amount of information dis- Kalli R. Davis, B.S. / M.A. is a second-year medical student
2017.11.007
menopausal women, it is important that the healthcare community closed during a consult, which is more frustrating to patients with lim- at UIWSOM in San Antonio, Texas and a member of the
9 . Zurawin, R. K., Fischer, J. H., 2nd, & Amir, L. (2010). The effect of a gyne-
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address literacy challenges in helping patients understand UF. ited health literacy. This is evident in studies showing hesitancy among Bexar County Medical Society. cologist-interventional radiologist relationship on selection of treatment

UF can significantly decrease the quality of life for affected women, patients with limited health literacy to ask questions that would facil- modality for the patient with uterine myoma. Journal of minimally invasive
Matthew D. Parker, MD is a Vascular and Interventional
prompting them to seek treatment for symptom relief. Our focus is itate greater comprehension and indicates a bias by providers to com- gynecology, 17(2), 214–221. https://doi.org/10.1016/j.jmig.2009.12.015
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Radiology PGY-2 at UTHSC Long SOM and is the Co-Chair 10 . Durand, M. A., Carpenter, L., Dolan, H., Bravo, P., Mann, M., Bunn, F., &
on combating low health literacy as a barrier to achieving shared de- pensate with a paternalistic approach to care.
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of the SIR RFS Research and Innovation Committee. Elwyn, G. (2014). Do interventions designed to support shared decision-mak-
cision making for selection of treatment in patients with UF, with par- A survey conducted by the Society of Interventional Radiology
ing reduce health inequalities? A systematic review and meta-analysis. PloS one,
ticular emphasis on how collaboration between healthcare providers (SIR) found that 59% of women diagnosed with UF expressed that Ariana Lewis, MD is a fourth year OBGYN resident at 9(4), e94670. https:/doiorg.uiwtx.idm.oclc.org/10.1371/journal.pone.
can help overcome this limitation to increase patient satisfaction and ‘knowing their doctor discussed all treatment options with them is the UTHSCSA. She is pursuing a career as an academic specialist 0094670
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quality of life. most important factor for selecting a treatment.’ However, studies in general obstetrics and gynecology.

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